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ORIGINAL ARTICLES — VOLUME VII ' 



A Short Study In Dislike. By William D. Tait 1 

A Forgotten Dream. By Ernest Jones 5 

Poetry and Dreams. By F. C. Prescott 17-104 

Preliminary Note on the Physiognomical Reflex. By 

Smith Baker 47 

Critique of Impure Reason. By Frederick Lyman Wells . . 89 

The Evolution of Sleep and Hypnosis. By Isador H. 

Coriat 94 

The Treatment of Writer's Cramp and Other Occupational 

Neuroses. By Tom A. Williams 99 

Interpretation of "Professional-Cramp-Neurosis" as a Tic. 

By Tom A. Williams 161 

An Hypnagogic Hallucination with Dream Characters. 

By C. S. Yoakum 167 

The CEdipus-Complex in the Psychoneuroses. By Isador 

H. Coriat 176 

Anal Eroticism and Character. By A. A. Brill 196 

Report of a Case of Versuchung Angst Attended by Visual 
Hallucinations of a Homicidal Nature. By G. A. 
Young 204 

The Meaning of Ideas as Determined by Unconscious 

Settings. By Morton Prince 233 

A Clinical Study of a Case of Phobia — Symposium. 

By Morton Prince 259 

By James J. Putnam 277 

Proceedings, of the American Psychopathologlcal Asso- 
ciation, May 29, 1912. Discussion 293-349 

Conditions for a Home of Psychology in the Medical 

Curriculum. By Adolf Meyer 313 

On the Somatic Sources of Somatic Delusions. By E. H. 

Southard 326 

Psychoanalysis and Society. By Trigant Burrow 340 

A Note on the Color Sense in Relation to the Emotion of 

Sex. By George Henry Taylor 347 

A Psychoanalytic Study of a Severe Case of Hysteria. 

By L. E. Emerson 385 

Psychogenetic Disorders In Childhood. By T. A. Williams, 407 

The Mental Manifestations of Epilepsy. By N. S. Yawger, 420 



INDEX TO SUBJECTS 

(Figures with asterisks indicate original articles. Figures without an asterisk 
indicate abstracts, reviews, critical digests, society reports, and discussions. The 
names of the authors are given in parentheses.) 

Affective Epileptic Attacks (Bratz, Stallman, Friedman) . . 304 
American Psychopathological Association (Proceedings) . .*293,349 

Anal Eroticism and Character (Brill) *196 

Association of Ideas (Ley and Menzerath) 224 

Association for Medical Psychology and Psychotherapy. . . 87 

Attention (Rignano) 67 

Attention, Psychopathology of (Prager) 58 

Child, Sexual Life of the (Moll) . . . . .^ 449 

Childhood, Psychogenetic Disorders in (Williams) *407 

Color Sense in Relation to Sex (Taylor) *347 

Consciousness of Self (Titchener) 309 

Das Ich-Erlebnis (Bloch) 437 

Dementia Prsecox (Pascale) 155 

Dementia Prsecox (Bleuler) 374 

Depersonalization (Dugas and Moutier) 152 

Dipsomania (Julius Burger) 362 

Dislike, A Study in (Tait) *1 

Dream, A Forgotten (Jones) *5 

Dreams and their Meaning in the Middle Ages (Diepgen) . . 380 

Dream Investigations (Void) 374 

Dreams and Psychoneuroses (Jones) 62 

Dreams, World of . . . (Ellis) ; 70 

Dyspsychies (Dide) 432 

Educational Psychology (Pyle) 440 

Emotions and the Subconscious (Ferrari) 366 

Epilepsy, Mental Manifestations of (Yawger) *420 

Everyday Life, Psychopathology of (Jones) 60 

Hallucinatory Delirium (Masseton) 433 

Human Efficiency in Business (Scott) 312 

Human Problems, Biological Aspects of (Herter) 382 

Hypnagogic Hallucinations (Yoakum) *167 

Hysteria, Psychoanalysis of (Emerson) *385 

Ideas as Determined by Unconscious Settings, The Mean- 
ing of (Prince) *233 

Imagination, Experiments on in Mental Disease (Levy- 

Suhl) 229 

Impure Reason, Critique of (Wells) *89 

Jahrbuch f. Psychoanalytische U. Psychopath. Fdrsch. 

(Abstracts of articles) 80, 82 

Laughter (Bergson) 373 

Mental Healing (Bruce) 71 

Mind, Evolution of (McCabe) 220 

Mind of Primitive Man (Boas) 220 

Motive Force and Motivation-Tracks (Barrett) 441 

Nerves, Conquest of (Courtney) 149 



-TTT 

Nightmare (Jones) 144 

Nightmare in Beb'ef of Middle Ages (Jones) 444 

CEdipus-Complex (Coriat) *176 

Perception, Phy iological Analysis of (Abramowski) 377 

Phobia, A Clinical Study of a Case of (Prince) *259 

Phobia, A Clinical Study of a Case of (Putnam) *277 

Physiological Psychology (Ladd and Woodworth) 147 

Poetry and Dreams (Prescott) *17, 104 

Professional Cramp Neurosis (Williams) *161 

"Profiles," Psychological (Rossolimo) 436 

Pseudologia Phantastica (Wendt) 66 

Psychoanalytic Method (Seif) ' 55 

Psychoanalysis (Brill) 447 

Psychoanalysis and Society (Burrow) *340 

Psychasthenia and Inebriety (Williams) 68 

Psychogenetic Convulsions and Epilepsy (Clark) 217 

Psychological Constellations (Pfenninger) 359 

Psychology, Introduction to (Wundt) 451 

Psychology, Conditions for a Home of, in the Medical 

Curriculum (Meyer) *313 

Psychological Methods (Sommer) 63 

Psychoneuroses (Dornbliith) 158 

Psychoneuroses, Clinical Differentiation of (Bernheim) . . . 57 

Psychopathic Personalities (Meyer and Puppe) 368 

Psychopathic Constitution (Zeichen) 434 

Reflex, Physiognomical (Baker) *47 

Renata, Case of (Schnyder) 429 

Reserve Energy (Williams) 371 

Sleep and Hypnosis, Evolution of (Coriat) *94 

Somatic Delusions, The Somatic Sources of (Southard) . . . *326 

Stammering (Appelt) 150 

Stuttering and Lisping (Scripture) 379 

Suggestion, Problems of (Janet) -53 

Thought-Reader, Investigations of a (Sommer) .......... 218 

Versuchung-Angst (Young) *204 

Writer's Cramp, Treatment of (Williams) *99 

Writer's and Telegrapher's Cramp, Studies of the Genesis 

of (Williams) *219 

Zentralblatt f. Psycho Analyse (Abstracts of articles) 73 



CONTRIBUTORS TO VOLUME VII 

Allen, Alfred R 353 

Baker, Smith . 47 

Brill, A. A 196, 297, 352, 356 

Burrow, Trigant 53, 55, 57, 340, 351 

Clark, L. P 217, 298, 357 

Coriat, Isador H 67, 70, 94, 150, 176, 296, 354, 356, 429, 449 

Dearborn, G. V. N 58, 71, 147, 220, 382,441 

Donley, John E , 149 



Emerson, L. E 298,385 

Jones, Ernest. .5, 60, 62, 63, 66, 73, 74, 80, 82, 87, 218, 299, 349, 

351,354,357 

Karpas, Morris J 362 

Kline, L. W 4i0 

Meyer, Adolf 300, 303, 313, 357 

Onuf, B 296 

PIcken, J. H 451 

Prescott, F. C 17, 104 

Prince, Morton 233, 259, 300, 303, 355 

Putnam, James J 277, 295, 297, 302, 349, 350, 444 

Reed, Ralph 354 

RIcksher, Charles 304, 359 

Southard, E. E 326 

Starch, Daniel 312 

Swift, W. B : 379 

Talt, William D 1 

Taylor, E. W 144, 293, 295 

Taylor, G. H 347 

Van Teslaar, J. S.. .152, 155, 158, 224, 229, 309, 366, 368, 373, 

374, 377, 380, 432, 433, 434, 436, 437 

Wells, F. L 89, 447 

Williams, T. A .68, 99, 161, 219, 299, 349, 371,407 

Yawger, N. S 420 

Yoakum, C. S 167 

Young, G. A 204, 349 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



APRIL-MAY, 1912 



A SHORT STUDY IN DISLIKE 

BY WILLIAM D. TAIT 

McGill University 

DURING a series of experiments with colors it was 
found that some subjects had some very strong likes 
and dislikes. One dislike in particular, which was 
unreasonable to the experimenter as well as to the 
subject himself, seemed worth while investigating, all the 
more so, as no reason could be given, nothing could be re- 
called which would throw any light on the matter. The 
idea was to see if any buried memory complex could be 
brought to consciousness. 

It should be stated that the subject is an experimenter 
himself, and has had several years' experience in the psy- 
chological laboratory, so that a case like this is worth more 
than one where the subjects are to some degree new to such 
work, expecially in experiments of this kind. 

The following instructions were given to the subject. 
Take the word "brown" (this being the color so heartily 
disliked) and write it down five times with as much con- 
centration of attention as possible. Then start the metro- 
nome at about forty and write a word for every beat. (That 
was the ideal.) Do not criticize what you write. Give 
yourself a free hand as much as possible. A passive state 
will aid you. 

The following list of words was obtained from the 
subject. The introspection is also subjoined: 

1 



A Short Study in Dislike 



man 


write 


medical school 


man 


run 


woman 


work 


stiff 


strike 


hand 


child 


write 


work 


fall 


head 


animal 


No. 1 


odor 


back 


hold 


cat 




face 


blood 


cry 


dog 


BROWN 


jaw 


No. 2 


fear 


woods 


green 


sore 




shudder 


forest 


red 


cake 


blood 


strike 


stream 


blue 


scab 


boy 


head 


brook 


yellow 


parotid 


swing 


hurt 


trout 


orange 


gland 


barn 


fall 


fish 


green 


sore 


high 


blood 


line 


blue 


blow 


push 


red 


hook 


brown 


strike 


fall 


brown 


bait 


yellow 


wound 


break 


red 


fly 


blue 


die 


fall 


blood 


fish 


red 


man 


swing 


head 


trout 


blood 


strike 


floor 


fall 


eat 


red 


jaw 


beam 


hurt 


food 


dark 


blood 


strike 


run 


table 


night 


red 


dizzy 


cry 


cafe 


red 


dark 


head 


home 


hotel 


dark 


red 


hurt 


fear 


home 


blue 


brown 


blood 


head 


read 


wax 


blood 


look 
frighten 


hold 
hurt 



Comment is almost unnecessary on such an excellent 
piece of introspection as the following: 

"I started out in the usual way as passive as possible, 
but soon became conscious that I was failing essentially, 
and I stopped at No. 1. I then decided that it was per- 
fectly legitimate to start out with 'brown,' and that led 
me to an interesting complex in the medical school, of some 
two weeks before. I had been doing dissection work on an 
unusually 'ripe' old stiff, and when I had removed the 
skin and superficial fascia from the face, I came upon a 
badly diseased and decayed parotid gland. There was a 
brown clot on the surface of it running down in a malignant 
decay to the jaw itself. That brown I remember at the 
time was especially disturbing and repulsive to me, and I 
stood looking at it for some time — at that time I had quite 



William D. Tait, Ph.D. 3 

forgotten my. particular complex for 'brown.' Then I 
felt in the pocket of my laboratory coat for my rubber gloves 
before continuing the dissection of the superficial muscles 
of the face. When I reached point No. 2 (in list of words) 
the whole thing dawned on me — or at least I believe what 
may be the complex came to mind. 

"It reverts to childhood, just the year I cannot say, but 
it was between the age of seven and ten. I was visiting my 
grandmother (summer time), and a swing had been con- 
structed in the barn, where I and my two playmates spent 
most of our time. As I look back now that barn was a most 
mysterious place to me — very mysterious — full of pits 
and rats. Yet in the daytime we explored it without fear. 
Late one afternoon, while I was swinging alone, one of the 
ropes broke and I took a bad fall backwards, hitting my head 
a glancing blow on a floor support. I remember, now, dis- 
tinctly, my dazed condition as I turned to look at what 
I had hit, and saw drops, several of them, of reddish-brown 
blood. Brown, I suppo&e, because I was somewhat dazed. 
I quickly put my hand to the back of my head and found 
it wet. I had given myself a rather severe cut on the scalp, 
and it was bleeding badly. I remember the unusual feeling 
of my fingers as they touched the bruised spot wet with 
blood. It was the first time, so far as I can recall, that I 
had personally come in contact with blood. In real child- 
hood fear, I jumped up, crying, and rushed to my grandmother. 
When I went to the barn next day those spots were brown, 
and it is that way and from that strong emotional experi- 
ence of childhood that I look to an explanation for my dis- 
taste for brown. 

"The words coming after No. 2 are merely a conscious 
effort on my part to put down in the sequence of the moment 
the associations as they came to mind after the flash of 
recognition which embodied a fairly clear visual picture of 
that childhood tragedy." 

It is interesting to note that this little piece of work 
illustrates in an experimental way on the normal individual 
some of Freud's work. During the course of another in- 
vestigation several such cases occurred, but in them the 
subjects were able after some effort to trace them back to 



4 A Short Study in Dislike 

early emotional experiences. They all show an inhibiting 
effect on other mental material. The same happened in 
this instance. In a series of colors exhibited, those most in- 
tensely remembered were the browns to the exclusion of 
practically all else. A feeling of hatred accompanied this 
remembrance which spread itself over the whole experiment 
with colors. This is all the more remarkable as the subject 
is something of an artist, and colors as colors are not distaste- 
ful to him. 

It seems altogether probable that the account given 
by the subject is correct and that the dislike dates from that 
vivid experience of childhood. The original experience had 
been completely and entirely forgotten, but the emotional 
effect remained to color future impressions. Unless the 
word emotion is given a broader meaning than at present we 
require a wider and more inclusive word to express the con- 
dition or state when such an experience is awakened without 
the original cause being present in memory. A word is 
needed to cover emotion, instinctive action, organic action, 
feeling. The best at present would seem to be psycho- 
physical attitude. It would include practically all reac- 
tions of the organism, those which have a conscious content 
of their own (in the current use of the word consciousness) 
and those which have it indirectly, such as reflex actions 
and organic feelings, etc. It is true that the word con- 
sciousness should cover all these and then" the term attitude 
can be used to differentiate a region within consciousness. 
This is coming, for one can now proceed with some success to 
analyze all reaction into a sum of reflexes, some of them 
accompanied by self-consciousness and some not. The 
point here is that these so-called vague attitudes, organic 
feelings and reactions play a larger part in the ordering of 
our mental life than we are aware. They are the back- 
ground or foundation on which all the rest of the reactive 
edifice is built. They often decide what we shall remember 
and what we shall not remember; in fact, they are the main 
causes for suppressed complexes. 



A FORGOTTEN DREAM 

NOTE ON THE CEDIPUS SAVING PHANTASY 
ERNEST JONES, M.D., M.R.C.P. (lONDOn) ^ 

Associate Professor of Psychiatry^ University of Toronto 

A MATTER established by experience in dream 
analysis is that all dreams of the same night are 
concerned with different aspects of the same 
theme. During the investigation of one dream it 
often happens that the memory of a second one, which 
has been forgotten through repression, is recovered as 
soon as the repressing resistance that caused it to be for- 
gotten has been overcome through psycho-analysis of the 
first. The following dream analysis^ is a striking example 
of this, and as it presents other features of general interest 
it would seem to be worth relating. It should be men- 
tioned that the subject of the analysis, a university teacher 
of a branch of biology, is quite normal, and presents no 
neuropathic traits. 

I 

The subject dreamed that he was in a dark cave full of, 
water; it had tzvo openings^ side by side. Opposite to him was 
a puppy whining to come out. Coming behind the puppy 
were two cats. He set out to rescue the puppy^ which during 
the procedure seemed to fuse into his personality. He was in 
great danger of drownings but clung to some bushes which 
were at the side of the cave^ and at last safely emerged. Standing 
outside was his father^ who was quite unconcerned. He 
wondered that his father had not helped him, and supposed it 
was because he had not realized the extent of the danger. He 
impressed on his father the danger he had come through, and 
boastfully told him that he had saved himself without any help. 

The dream belongs to a class that can almost be called 
typical; any one practised in dream analysis can at once 

*It will be understood that in the following account most of the steps of the 
actual analysis are not mentioned, it not being the purpose of the present article 
either to expound the technique of dream analysis or to defend its reliableness. 



6 A Forgotten Dream 

interpret it without any trouble. Emergence, after great 
difficulty, from a dark chamber containing water, is a very 
usual way for unconscious thoughts about the birth act to be 
expressed; the dark cave in the dream, with its two open- 
ings, represents the mother's body, or womb, enclosing the 
uterine waters. In mythology the situation is more often 
reversed by the hero being placed in an enclosing chamber 
and put into^ or on to, water,^ such as with Moses in the 
bulrushes, Noah in the ark, and so on; as a rule the more 
important the hero, especially when he is made the ancestor 
of all mankind, the more extensive is the flood of water. 
The subject of the present dream and his wife ardently 
desire a child, but their parental longings have to be content 
with a puppy dog, to which they are very much attached. 
On the "dream-day," i.e., the day immediately preceding 
the dream, this dog got accidentally shut up in a distant 
room, from which the subject, notified by the whining, 
released him, an incident which doubtless served as one of 
the instigators of the dream. 

Behind this simple wish, however, which was, of course, 
in no way repressed — though it was invested with a painful 
feeling-tone because it could not be fulfilled — lay deeper 
and older thoughts. In the dream the subject identified 
himself with the dog; it was thus a question of his own birth. 
This explains the subsequent appearance of the two cats, 
an uncomplimentary reference to his younger sisters, who 
have a marked propensity to quarrelling.^ Dreams and 
phantasies concerning one's own birth are very common, 
especially in childhood, and are generally connected with 
the desire to have children of one's own. The phantasies 
in question are of considerable importance in psychopatho- 
logy, since they constitute the basis of such phobias as those 
of being buried alive, of being shut in an enclosed space 
(claustrophobia), and many others. The whole range of 
morbid anxiety phenomena, indeed, stand in an intimate 
relation to the actual birth event, which is the first anxiety 

»See Otto Rank, Der Mythus von der Geburt des Helden. 1909. S. 69-72. 

n^'his symbolism had an older source, less ungallant, in the fact that, like so 
many other children, the subject used to regard all dogs as male and all cats as 
female. 



Ernest Jones^ M.D. 7 

experience of the individual, and which serves as an arche- 
type for all later manifestations (compression, suffocation, 

etc.).' 

Appropriately enough for this interpretation is the fact 
that the enclosed cavity in the dream was in the earth. 
Mother Earth as a symbol for the mother is familiar to 
us in poetry, mythology, and folklore; in Watts's beautiful 
picture, "The All Pervading," for instance, it is used actually 
to symbolize the female generative organs. On the dream- 
day the subject had been reading some literature of the 
middle ages in which it described how the devil frequented 
remote and inaccessible caverns in the earth, and, as he was 
familiar with my theory that the idea of the devil is a pro- 
jection of the child's thoughts concerning the father,^ 
he had readily perceived the significance of the description. 

The portrayal of the act of birth by a deed of saving 
life is a theme to which much attention has been paid of 
late by Freud^ and others.^ It originates in the gratitude 
felt by the boy to his mother on hearing that his life was a 
gift made by her at the risk of her own. The phantasy of 
saving her life, or some one's in her presence, represents 
the grateful desire to repay her by doing for her what she 
did for him, i.e., by making her a gift of a life. To give a 
woman a child signifies to make her a mother, and the 
phantasy just mentioned naturally becomes associated in 
the unconscious with incestuous thoughts; the full rendering 
of it, of course quite repressed, would therefore run "to 
show his affection and gratitude to the mother by be- 
getting a child by her." The idea of gift is never very 
far in this connection; with a woman the thought of having 
a child by a certain man is often expressed in the words 

'Freud. Die Traumdeutung. 1909. S. 199. 

^Schriften zur angewandten Seelenkunde, Heft XV, Ch. 6. 

'Freud. "Beitrage zur Psychologie des Liebeslebens." Psychoanalytisches 
Jahrbuch, 1910, Band II, S. 389. 

*Otto Rank. "Belege zur Rettungsphantasle." Zentralbl. f. Psycho- 
analyse, Jahrg. 1, S. 331; and Die Lohengrinsage. 1911. Ch. VII. S. 87-131. 
Reik. "Zur RettungssymboHk." Zentralblatt f. Psychoanal. Jahrg. I. S. 499. 
Stekel. "Elnige Bemerkungen zur Rettungsphantasle und die Analyse eines 
Rettungstraumes." Zentralbl. f. Psychoanal. Jahrg. I. S. 591. 



8 A Forgotten Dream 

"to give me a child of his." The later elaborations of this 
phantasy of saving are very important for the psychology 
of many impulses and reactions in adult life, but for an 
account of them the reader must be referred to the writings 
of Freud and Rank. 

The deeper layer of the dream thus represents an old 
childhood wish of the subject's to have a child by his mother, 
but there is more than this. One cannot fail to be struck 
by the plain hint of his relation to his father in the matter, 
which in the light of our interpretation becomes quite 
comprehensible. He had nurtured feelings of hostility 
to the father, unconscious since early childhood, which had 
originated partly in his jealousy at being disturbed by him 
in the exclusive possession of his mother's affection,^ and 
partly in the stern rebuff with which his father had treated 
his desire for enlightenment on forbidden topics. In the 
dream these feelings obtain full revenge. Not only does 
he proudly demonstrate to the father his independence in 
these matters, and that he is master of the situation without 
any external help or advice, but he further dispenses with 
the father altogether in regard to the question of his own 
birth. He has begotten himself, is his own father, like 
the divinities and heroes of old.^ He has satisfactorily 
solved the problem of birth in general, and of his own in par- 
ticular, and the dream is a panegyric of his superiority 
to his father. 

After completing the main part of the analysis^ I pursued 
further one part of it in particular, namely the dog symbolism, 
and this on account of the frequency with which the same 
symbolism occurred in the subject's dreams. In the present 
dream he identifies himself with the dog while in the act 
of putting himself in his father's place ;^ the dog thus sym- 

*See Freud, Die Traumdeutung, S. 180-187, and Ernest Jones, American 
Journal of Psychol., Jan., 1910, pp. 93-97. 

f^See Rank, Der Mythus, Op. cit. 

'At this point attention may be called to the striking resemblance between 
the dream-phantasy just detailed and the story of CEdipus, who saved his mother 
( — town) by solving the riddle of the Sphinx (psychologically the same riddle as 
that solved by our subject in his dream), married his mother, displaced his father, 
and reigned in his stead. 

^Cf. the expression, "He became top dog." 



Ernest Jones^ M.D. 9 

bolizes in turn the subject's child, himself, and his father. 
From earlier analysis we knew that in his unconscious the 
idea of dogs was closely associated with that of sexuality,^ 
and that in his dreams a dog frequently symbolized either 
his father or mother. On the dream-day he had been read- 
ing a book on totemism and animal-ancestry, and it was 
evident that the same association between animals and 
ancestors existed in his unconscious as exists in the savage 
mind. The question arose as to how this association had 
originally got formed in his mind. There is no need to go 
into the details of the matter here, which was largely con- 
cerned with infantile sadistic conceptions, but the first 
point to come out has a direct bearing on the present theme. 
The only dog the subject had had much to do with in early 
years was one he had been given at the age of eight by a 
man he was very fond of, and to which he became extraor- 
dinarily attached. When he was unhappy he would take 
it for a long walk and spend the whole day as far as possible 
from home. The dog was a female one, but was invariably 
referred to at home as "he," and could thus be used to sym- 
bolize a person of either sex; her name was "Fanny." The 
only women he had known of this name in his youth was a 
Miss Fanny W., a lady some ten years younger than his 
mother. He had been very fond of her and her mother, 
who were especially kind to him. Whenever he visited 
them Miss W. used to enquire with peculiar friendliness 
after his mother, whom she had been intimate with in earlier 
years, but with whom, for irrelevant reasons, she was no 
longer on visiting terms; the idea of Miss W. was thus 
closely connected with that of his mother.^ At this point 
the subject suddenly recalled an earlier dream of the same 
night, which he had thought of on waking, but which he had 
then quite forgotten until this moment; we have next to 
turn our attention to this dream. 



'This is of course quite common, as is indicated by the mere expression "animal 
passion "= sexual desire. 

^This was the first step of an analysis which showed that in the subject's 
unconscious his mother and the dog Fanny had long been identified. In the dream, 
therefore, the subject saves his mother as well as himself. 



10 



A Forgotten Dream 
II 



He was in his father'' s office with Mr. /F., who was ex- 
pounding to him his genealogy and early life. Mr. W., 
the father of Miss Fanny W., was an old man, who had 
been a colleague of his father's and had worked in the same 
office. The subject had never seen much of him — he had 
died when the latter was ten years old, — and he had not 
to his knowledge thought of him for many years. The coin- 
cidence of his appearing in this particular dream is therefore 
certainly striking. 

On the dream-day the subject had been thinking about 
a projected visit to his family home, where he had not been 
for several years, and had expressed the hope that his aged 
grandmother would be still alive — for the egocentric 
reason that he could then ask her about a number of matters 
concerning his infancy in which since psycho-analysis he 
had become interested; his mother had lately died, and he 
did not care to talk to his father about them. Now his 
grandmother's daughter (his aunt on the father's side) had 
married Mr. W.'s son, now dead, a relationship more clearly 
shown in the accompanying table. Mr. W. and the grand- 



Mr. w. 



Granny W. 



Grandmother 



Fanny 



Son 



Aunt 



Father 



Mother 



Subject 



mother could thus be brought into near connection, they being 
the parents of the same couple, a connection furthered by the 
circumstance that Mr. W.'s wife was always addressed by 
the subject as Granny W. In the dream Mr. W. replaces 
the grandmother in giving the subject the desired informa- 



Ernest Jones, M.D. 11 

tion about his origin and upbringing. Two wishes lie 
behind this apparently senseless replacement: first the old 
desire that the father would respond to his request for en- 
lightenment about the problem of his birth, and secondly, 
the old revengeful desire that the father might resemble 
Mr. W. and his son (of the same generation as the father) 
in the respect of having departed from this life. 

More than this: On the dream-day the subject had 
wished to question his grandmother because his mother was 
no longer accessible. She therefore replaced the latter in his 
mind, and as she was replaced in the dream by Mr. W. we 
reach the conclusion that the figure of the latter stood not 
only for the father, but also for the mother; this reminds us 
of the original connection between the two via Fanny. 
The dream is thus seen to be built on the basis of childhood 
sexual curiosity, and the desire that the parents would 
gratify this. 

Though the basis of the dream is, as has just been ex- 
plained, a childhood one, more current wishes also come to 
expression in it. On paying closer attention to the details 
It was noticed that the main figure really constituted what 
is known as a "collective person" (Sammelperson),^ being 
composed of three persons condensed into one. Although 
it seemed in the dream definitely to represent Mr. W., and 
the place was the only one where the subject had ever seea 
him, the face resembled a Mr. A. rather than Mr. W.; 
the two men were in fact very much alike in appearance. 
Mr. A. was an elderly man in whose office the subject had 
worked some years ago, and who still owed him a considerable 
sum of money in consequence. Owing to financial difficul- 
ties he had not been able to pay this off, but had promised 
to pay a quarter of it on a date some eight months before 
that of the dream. He had not fulfilled the promise, and 
this had rather embarrassed the subject, particularly as he 
had just then to meet heavy expense in connection with a 
.projected removal from one country to another. Two 
days before the dream, a week before the subject was to 
leave, the long-awaited cheque arrived, but he found to 

'See Ernest Jones, Amer. Jour, of Psychol., April, 1910, p. 287. 



12 A Forgotten Dream 

his chagrin that it was post-dated and payable only a month 
later. On the dream-day he wrote a somewhat stiff letter 
in acknowledgment, explaining his situation, and remarking 
that as he had closed his own bank account he would have 
to send the cheque to his father (in the country he was going 
to), and "trust to his honesty to get the money back." 
While in the middle of writing the letter he noticed that 
the cheque was made out for twice the amount he expected, a 
discovery that led him to mollify his remarks and gratefully 
to thank Mr. A. for having done all that he could under the 
circumstances; we see here again the same alternation of 
friendliness and hostility that characterizes the whole of 
his attitude towards the father and his substitutes. 

The curious remark in regard to his father's honesty 
was greatly "overdetermined." It pointed in the first place 
to an unconscious identification of the father with the 
elderly Mr. A., the annoyance with the latter having evoked 
a manifestation of the old hostility towards the former. 
The remark was not only unwarranted in fact, but was quite 
pointless, for the father was a scrupulously honest man. 
According to the subject the only unfair thing he had ever 
done in regard to money was to make a will recently in 
which he disinherited his son and left all his property to his 
two daughters. There were, it is true, special reasons for 
his doing so, and the subject had not -only acquiesced in it, 
but had even advised it; nevertheless it was plain that he had 
not entirely forgiven his father for being so ready to over- 
look him. This reproach he had unconsciously linked to 
the old one about being kept in the dark as a child and 
dishonestly lied to on matters of great significance to him. 
The way in which this apparently strained association wal 
forged cannot here be related, as it would necessitate too 
long a discussion; the cloacal connection will be evident 
to those familiar with psycho-analysis. 

Unlike both Mr. W. and Mr. A., the figure in the dream 
was quite bald and there was a wart by the side of the nose. - 
These characteristics, and the upper half of the head in 
general, at once reminded the subject of Charles Darwin. 
The singular appropriateness will be admitted of the pro- 
blem of personal origin being expounded by the author of 



Ernest Jones, M.D. 13 

"The Descent of Man " and "The Origin of Species." As a 
student of biology the subject had greatly revered Darwin, 
who had, so to speak, answered the question he had pro- 
pounded in vain to his own father; it was evident that uncon- 
sciously he had identified the two men, Darwin being to him 
what he had wished his father to be — an expounder of the 
problem of origin. Strangely enough, Darwin had on the 
dream-day been the topic of conversation between the subject 
and his wife. Being concerned at his over-working she had 
urged him to give up some of his routine teaching 
work so that he might devote himself more peacefully 
to his favorite pursuit of scientific research, and had con- 
siderately volunteered to do with less money. The talk 
drifted on to the endowment of research, and the subject 
remarked on what a fortunate thing it was for mankind that 
Darwin had inherited enough money from his father to 
enable him to pursue his investigations undeterred by 
material considerations. He here was evidently identifying 
himself in his unconscious — that realm of unlimited 
egoism^ — with Darwin, i.e. once more with his father, 
and was at the same time mutely reproaching his father 
for not having bestowed him with more worldly goods. His 
father had spent vainly many years in the service of other 
people, and had quixotically refused to seize opportunities 
for his own advancement. In the sentence written to 
Mr. A., referring to his father, the subject had unwittingly 
expressed the wish that his father had in fact been a little 
less pedantically honest, so that he might have been able 
to bestow him with more money. 

The three persons figuring in the dream are thus all 
substitutes for the father. Each one is connected both 
with the subject's "money-complex," i.e. his complaint 
that he was worried about money matters, and also with 
the deeper reproach against his father regarding the question 
of sexual curiosity. Both these complexes are evident 
in the case of the Darwin component of the figure, as is the 
former with Mr. A. and the latter with Mr. W. The series 



"im Unbewusste glaubt Jeder an die AUmacht seiner Gedanken, an die 
Unwiderstehlichkeit seiner Reizen, und an die Unsterbiichkeit seiner Seele." 



14 A Forgotten Dream 

may be completed by mentioning the following two facts. 
A prominent memory the subject had of Mr. A. was a 
morbid interest taken by the latter in the sexual thoughts 
and curiosity of children. As to the relation of the money 
complex to Mr. W., it is enough to say that he was closely 
connected with the subject's father in the financial aspects 
of the business they were both concerned with. Both 
complexes were thus associated with each of the three 
constituent persons of the dream figure. 

Ill 

The analysis just given of the two dreams, or two halves 
of a dream, confirm to the full Freud's theory of dreams, 
which has been most precisely formulated by Rank^ in the 
following terms: Der Traum stellt regelmdssig auf der Grund- 
lage und mit Hilfe verdrdngten, infantil-sexuellen Materials 
aktuelle in der Kegel auch erotische Wiinsche in verhullter und 
symbolisch eingekleideter Form als erfullt dar. 

We see that the dream as told, the "manifest content," 
is quite senseless and even absurd, but that the hidden 
meaning, or "latent content," revealed by analysis, is 
thoroughly intelligent and full of meaning. Further, that 
although the manifest content may seem to deal with situa- 
tions that, so far as the psyche is concerned, are harmless 
or unimportant, the underlying thoughts are highly sig- 
nificant and are related to the most intimate part of the 
subject's personality. Behind the manifold processes in 
the dream structure — which by a superficial study might 
be mistaken for the true latent content — stands the pri- 
mordial basis of all our mental activities, the Wish. The 
current wishes of the actual moment, the ones that aroused 
the memories which threatened to disturb the subject's 
sleep, were two, one erotic, the other non-erotic, namely 
the desire to have a child and the desire to be free from 
monetary cares; these two desires, however, were not 
really so independent as they appear. The current wishes 

*Otto Rank. "Ein Traum, der sich selbst deutet." Psychoanalytisches 
Jahrbuch, 1910, Band II, S. 519. Those who wish to read a really full dream 
analysis are referred to this excellent paper. 



Ernest Jones^ M.D. 15 

aroused deeper and older repressed thoughts with which 
they were connected, and on the basis of which the dream 
was constructed. These deeper thoughts were, as always, 
of infantile amd sexual origin. In the present case they 
concerned the most intimate relations of the subject to his 
parents: hostility, and to a less extent friendliness, towards 
his father, love and tenderness towards his mother. The 
natural desire to have a child awoke the old desire to repay 
his mother's sacrifice for him by presenting her with another 
child — of their very own; in this he plays the double 
part of both the child loved by the mother and the father 
who presents him to her. 

We see further the exemplification of the initial thesis 
from which we started, namely that different dreams of the 
same night are concerned with different aspects of the same 
theme. They often, as here, present different solutions 
of the same problem. In the earlier dream, the second 
here related, the father meets his childhood curiosity in a 
sympathetic and helpful manner; in the later dream he 
solves the problem without his father's help, and defyingly 
replaces his father in respect to the loved mother. In the 
former his homosexual component is gratified, in the latter 
his heterosexual. In the former he finds a man's solution, 
adopting a masculine attitude, in the latter he finds a 
woman's, adopting a feminine attitude. We have here, 
therefore, an illustration of the bisexual nature of the normal 
man. With the present subject, as with most men, the 
homosexual components of his instinct were more deeply 
repressed than the heterosexual, and it is thus entirely 
comprehensible that the dream expressing the former 
components was the one that proved the more susceptible 
of being forgotten; the question as to which of two dreams 
will be first forgotten may seem to be merely a matter of 
chance, but we see that the laws of psychical determinism 
hold here just as rigorously as elsewhere. Anyone trained 
in psycho-analysis will further perceive a good reason why, 
of two dreams relating to the begetting of children, it was 
in the feminine one that a money-complex came to expres- 
sion. Still another refinement may be added of the analysis 
of the feminine dream. The subject had often as a child 



16 A Forgotten Dream 

had the desire that the family doctor would present him 
with a baby of his own, and had elaborated phantasies in 
which he imagined himself the wife of this doctor, whom he 
greatly admired. The doctor had not only brought him 
and his sisters into the world, but had saved his life on two 
subsequent occasions when he was desperately ill; it was 
he who had presented him with the beloved dog Fanny, the 
dog so closely associated in his mind with the family of 
Mr. W. Mr. A also was nearly associated with doctors, 
being the head of an agency for the sale of medical practices. 
As to Darwin, he was both a doctor himself and the son of 
a doctor. The three components of the figure that plays the 
masculine part in the dream, therefore, all portray features 
not only of the father, as described above, but also of the 
family doctor who in the child's eyes seemed the "bringer 
of children" par excellence. 

Many of the individual features of Freud's dream 
theory are .also illustrated in the analysis, the almost gro- 
tesque egocentricity of the dream thoughts, the mechanisms 
of condensation, displacement, and regressive dramatisa- 
tion, and the importance as dream-instigators of incidents 
of the previous day. In the present case these were un- 
usually numerous; we have noted the puppy dog shut up 
in the room, the reading about the devil inhabiting caverns, 
the book on ancestor-worship, the thought of the projected 
visit home, the letter to Mr. A., the talk with the wife on 
money matters, and the reference to Darwin. Several of 
these cannot be described as being in any way psychically 
significant, but they had become associated to underlying 
complexes and thus proved suitable material to be used in 
the manifesting of these complexes. 

In conclusion I would express the hope that the re- 
ciprocal publication of actual material will do more to bring 
about a mutual understanding of different points of view 
than any amount of discussion, however open-minded. 



POETRY AND DREAMS 

BY F. C. PRESCOTT 

Cornell University 

POETRY is proverbially difficult to define and explain. 
The reason for this difficulty seems to lie partly 
in the subject itself and partly in our attitude toward 
it. The subject is indeed deep and complex. The 
production of poetry is still, as it has always been, a mys- 
terious process, even to the poets themselves; while even the 
most devoted and enlightened readers of poetry still find 
mystery in its action and effect. Poetry, as Shelley be- 
lieved, "acts in a divine and unapprehended manner, 
beyond and above consciousness."^ Many poets — for ex- 
ample Shelley and Wordsworth — in defining poetry resort 
to poetical figures; others, like our poet of democracy, 
avoid definition scrupulously. "Let me not dare," says 
Walt Whitman, "to attempt a definition of poetry, nor 
answer the question what it is. Like religion, love, nature, 
while these terms are indispensable, and we all give suffi- 
ciently accurate meaning to them, in my opinion no definition 
that has ever been made sufficiently encloses the name 
poetry."^ Perhaps, however, mystery in the subject en- 
genders superstition, and leads us to regard poetry with 
supine reverence and wonder. We should indeed worship 
our great poets, as the men of old did their bards and proph- 
ets; but not abjectly, as savages do their medicine men. 
We speak of the "divine" Shakespeare, perhaps knowing 
too little of this poet's life to recognize how much he shared 
our common humanity. We call poetry divine, which is 
another way of saying that it is still inexplicable to us. 
All things are of God; and in the subject of poetry, as in 
others, our increasing knowledge should lead us to clearer 
understanding. We need make no apology, then, for 
attempting to approach this mystery. 

There is some resemblance and unexplained relation be- 
tween poetry and dreams. The poet and the dreamer are 
somehow alike in their faculty of vision. This relation is 

' Defense of Poetry, ed. Cook, p. 11. 

"^ A Backward Glance o'er Travel'd Roads. 

17 



18 Poetry and Dreams 

indicated by the uses of language, which, spontaneously 
expressing the sense of mankind, often reveal psychological 
truth not otherwise readily discovered. The poets have 
traditionally been dreamers, from the "dreamer Merlin" to 
the latest youth who "dreams" and rhymes. The poet 
writes of "dreams which wave before the half-shut e} e." ^ 
The word dream is thus constantly used by critics in describ- 
ing the poet's work. "The true poet," says Charles Lamb, 
"dreams being awake." ^ Poetry is defined by Sully Prud- 
homme as "le reve par lequel Thomme aspire a une vie 
superieure." ^ The poets themselves in different times 
and different countries testify to the same effect, seeing not 
merely a metaphorical resemblance but an essential relation 
between dreams and poetry. -Hans Sachs, an inspired poet, 
thus speaks of the poet's inspiration:* 

"Mein Freund, das g'rad ist Dichter's Werk 
Dass er sein Traumen deut' und merk', 
Glaub mir, des Menschen wahrstes Wahn 
Wird ihm im Traume aufgetan: 
All' Dichtkunst und Poeterei 
Ist nichts als Wahrtraum-Deuterei." 

"The happy moment for the poet," says Bettinelli, 
"may be called a dream — dreamed in the presence of the 
intellect, which stands by and gazes with open eyes at the 
performance."^ "Genius," according to Jean Paul Richter, 
"is, in more senses than one, a sleepwalker, and in its bright 
dream can accomplish what one awake could never do. It 
mounts every height of reality in the dark; but bring it 
out of its world of dreams and it stumbles." ^ Goethe, 
using the same word, speaks of writing Werther " uncon- 
sciously, like a sleepwalker," and of his songs he says: 
" It had happened to me so often that I would repeat a song to 
myself and then be unable to recollect it, that sometimes I 
would run to my desk and, without stirring from my place, 
write out the poem from beginning to end, in a sloping 

* Thomson, Castle of Indolence, i, 6. 

"^ Essays of Elia, "The Sanity of True Genius." 

'For development of this admirable definition see Revue des Deux Mondes, 
Oct. 1, 1897, "Qu'est que la Poesie.?" 

*Die Meistersinger. Quoted by W. Stekel, Dichtung und Neurose, p. 2. 

* W. Hirsch, Genius and Degeneration, p. 32. 



F. C. Prescott 19 

hand. For the same reason I always preferred to write 
with a pencil, on account of its marking so readily. On 
several occasions indeed the scratching and spluttering of 
my pen awoke me from my somnambulistic poetizing." * 
Hebbel, after recording in his Journal, having actually 
dreamed an exceedingly beautiful but terrible dream, says: 
"My belief that dream and poetry are identical, is more and 
more confirmed." ^ Lamb, who was in spirit even more than 
in accomplishment a poet, believed that "the degree of the 
soul's creativeness in sleep might furnish no whimsical 
criterion of the quantum of poetical faculty resident in the 
same soul waking." ^ Such expressions suggest that dream- 
ing and poetizing, if not identical as Hebbel believed, are 
more than superficially related. If we wish to understand 
poetry, a clue like this, given us by the poets themselves, 
is worth following. 

Unfortunately, however, dreams are as little known to 
us in their true nature as poetry itself. Though they are 
as old as history — probably as old as mankind — they are 
still obscure in their cause and significance and their rela- 
tion to the ordinary mental processes. The people, in all 
countries and from the earliest times, have clung to the belief 
that they are significant, particularly as foretelling the future. 
Their interpretation, however, has always been vague and 
uncertain. The theories of modern psychologists do not 
ordinarily .go far or deep enough to be convincing or even 
interesting. Altogether the world of dreams has remained 
a mystery to us — -a world in which we live a fantastic 
secondary mental life curiously unrelated to that of waking, 
from which we return puzzled by our fleeting memories. 

A recent book of Professor Sigmund Freud promises to 

Quoted by Stekel, p. 2. 

Essays, "Witches and Other Night Fears." In Lamb's original manuscript 
(in the Dyce-Forster Collection at South Kensington) the final paragraph of the 
essay reads as follows: "When I awoke I came to a determination to write prose all 
the rest of my life; and with submission to some of our young writers, who are yet 
diffident of their powers, and balancing between verse and prose, they might not 
do unwisely to decide the preference by the texture of their natural dreams. If 
these are prosaic, they may depend upon it they have not much to expect in a crea- 
tive way from their artificial ones. What dreams must not Spenser have had!" 



20 Poetry and Dreams 

give us a better understanding of this subject of dreams.^ 
According to Dr. Freud our dreams are an integral part of 
our mental life, with definite origin and cause; they can be 
definitely interpreted and brought into relation with our 
waking thoughts and feelings; they are in certain respects 
similar to other mental activities with which we are fa- 
miliar; and they have a definite biological function which is 
important to our mental and physical well-being. This 
view of dreams forms part of an extensive and original 
psychological theory, developed by Dr. Freud, which is 
perhaps too new to be generally accepted — which, how- 
ever, undoubtedly suggests new views, not merely in the 
direction in which it was first mainly intended to be applied, 
but in many others — notably in literature. When I had 
occasion recently to become acquainted with this theory of 
dreams I was at once struck by the fact that many portions 
of it were equally applicable to poetry, so much so, indeed, 
that it occurred to me that Dr. Freud might have first 
developed his theory from poetry and then transferred it to 
dreams. I have since learned that this was not the case, 
that in fact he first approached the subject from a very 
different direction. The relation to poetry, however, is 
striking. 

I wish, then, in the first place to apply some portions 
of this theory to literary problems, in particular to transfer 
some of the conclusions in regard to dreams to the apparently 
related field of poetry, and to examine the evidence bearing 
on these conclusions which is supplied by literature. For 
the latter purpose I shall have to proceed mainly by quota- 
tion, even at the risk of trying the reader's patience. 
In fact, I do not wish to advance a new theory of poetry, or, 
for the most part, to express my own opinions; but rather to 
bring together and into relation some truths which have long 
since been expressed in poetry but have never been suc- 
cinctly stated in prose. 

Writing merely as a student of literature I shall have to 
assume the soundness of Dr. Freud's theory, though this 
may be still in debate among psychologists. Incidentally, 

Die Traumdeutung, second edition, 1909. For summaries of Dr. Freud's 
theory of dreams, see American Journal of Psychology, Vol. XXI, pp. 283, 309. 



F. C. Prescott 21 

however, I may be able to find some evidence bearing upon 
it in literature. New theories of this kind, if at all important, 
are seldom new in the sense that they have not been surmised 
and foreshadowed by poets and other imaginative writers. 
This is a part of the function of poets as prophets — to see 
truth imaginatively before it is grasped intellectually. It 
is one of the tests of new doctrines to ask if they thus find 
confirmation in literature. 

Let us return to the parallel between poetry and dreams. 
Let us take into consideration also, for further comparison, 
besides dreams and poetry, two other mental activities 
which seem on similar evidence to be related — waking 
dreams or "day dreams," and hysterical or neurotic halluci- 
nations and illusions. That nocturnal dreams and day 
dreams have some relation is suggested by their common 
designation, while day dreams frequently pass into halluci- 
nations. The word dream is supposed to be etymologically 
connected with the German trugen, to deceive, its fundamen- 
tal idea being illusion. There is also apparent resemblance 
between the illusions of hysteria and the visions of poetic 
or prophetic rapture. The question is. What may these 
several kinds of mental activity have in common.^ 



. I 

In a dream the scenes which we remember, with their 
grotesque figures and actions, and their curious emotional 
coloring, are called by Dr. Freud its "manifest content." 
The manifest content is usually strange to us and cannot be 
intelligibly connected with our waking experience. Behind 
these appearances, however, is the "latent content" — the 
underlying thought of the dream — the impulses and ideas 
contributing to form it, of which underlying thought the 
remembered dream is a distorted, fictitious, or, one might 
almost say, dramatic representation. The dream is a group 
or series of significant symbols. Its interpretation is like 
that of a dumb-show or a charade; it is a matter of finding the 
meaning which lurks behind, actuates, and explains these 
strange appearances. And this meaning when found — the 
underlying thought — is no longer unintelligible; it fits 



22 Poetry and Dreams 

clearly into the dreamer's mental life, indeed it regularly 
concerns what to him is most personal and vital. These two 
things, the manifest and the latent contents, it is important 
that the reader should keep distinct and clearly in mind. 
The interpretation of dreams, of their manifest content, is 
a difficult matter, involving a knowledge of the so-called 
"dream-work," — that is, of the strange processes by which 
the underlying thought is elaborated into the manifest 
content by the mind during sleep. 

The relation thus indicated between the apparent and 
the underlying thought of dreams will perhaps seem less 
novel to those accustomed to analyze and interpret works 
of literature and the other arts. Behind every work of 
creative imagination — poem, painting, or piece of archi- 
tecture — is the latent idea or motive impulse which in- 
spires and explains it. The Prisoner of Chillon, for example, 
was the work of a man who passionately desired personal 
liberty and so devoted himself to the liberty of mankind. 
The Gothic cathedrals were inspired by the religious 
devotion and aspiration which dominated the middle ages. 
They were built, says Emerson, "when the builder and the 
priest and the people were overpowered by their faith. Love 
and fear laid every stone." Behind Marmion and Ivanhoe 
lay a love, contracted in childhood, for the medieval past, — 
which Scott spent his life in trying to realize and reconstruct. 
Scott's poems and novels were inventions — so to speak, 
dreams — having their key in Scott's ruling impulse, which 
expressed itself thus through the working of his imagination. 
In some similar way our ruling impulses are clothed in 
fictional forms by a play of the imagination in sleep. 

Every dream, according to Dr. Freud — and this is one of 
the most important conclusions of the dream theory — has the 
same latent purport — to represent the imaginary fulfilment 
of some ungratified wish.^ The underlying thought may 
always be expressed by a sentence beginning Would that — . 
In the dream proper this optative is dropped for the present 
indicative, or rather for a scene in which the wish is visibly 
represented as fulfilled. In dreams of children the wish is 
•embodied openly; in those of adults it is commonly disguised 

^Die Traumdeutung, III, VII (c). 



F. C, Prescott 23 

and distorted in the representation. Thus, in the world of 
dreams, we obtain those things which are denied in the world 
of reality. We get money, place, children, friends, success in 
love, riddance of our enemies, — according to our desires. 
This fact is recognized by language in which dream is used 
for wish; to realize one's wildest dream is to obtain one's 
fondest wish. It is often recognized also in literature. 
"It shall even be as when a hungry man dreameth," says 
Isaiah, "and, behold, he eateth; but he awaketh and his 
soul is empty; or as when a thirsty man dreameth, and, 
behold, he drinketh; but he awaketh and, behold, he is faint, 
and his soul hath appetite."^ 

Our dreams do not always fulfil our wishes in the ob- 
vious way suggested by this passage. Sometimes these 
wishes are hidden even from ourselves. We do not recognize 
them as our true wishes; much less do we recognize that they 
receive a fanciful fulfilment in our dreams. But at bottom 
every dream is inspired by and gratifies some desire of the 
soul. 

Dr. Freud's theory of wish-fulfilment in dreams was 
probably not suggested to him by Nietzsche. It is, how- 
ever, in remarkable agreement with the theory advanced 
in the Morgenrothe.^ Nietzsche makes the supposition 
"that our dreams, to a certain extent, are able and intended 
to compensate for the accidental non-appearance of sus- 
tenance," or satisfaction for our cravings, "during the day." 
"Why was yesterday's dream full of tenderness and tears, 

Chap. XXIX, V. 8. So in Romeo and Juliet, each dreamer dreams according 
to his waking desire: 

"And in this state she [Queen Mab] gallops night by night 
Through lovers' brains and then they dream on love; 
O'er courtiers' knees, that dream on court'sies straight, 
O'er lawyers' fingers, who straight dream on fees, 
O'er ladies' lips, who straight on kisses dream. 



Sometimes she gallops o'er a courtier's nose. 
And then dreams he of smelling out a suit; 
And sometime comes she with a tithe-pig's tail 
Tickling a parson's nose as a' lies asleep. 
Then dreams he of another benefice." (Act I, Sc. 4.) 
^See the translation, The Dawn of Day, 1903, p. 118. The whole section, 
"Experience and Fiction" is most interesting. 



24 Poetry and Dreams 

while that of the preceding day was facetious and wanton, 
and of a previous one adventurous and engaged in a con- 
tinued gloomy search? Why do I, on one, enjoy inde- 
scribable raptures of music; on another, soar and fly up 
with the fierce delight of an eagle to most distant summits? 
T\yqsq fictions ^ which give scope and utterance to our cravings 
for tenderness or merriment, or adventurousness, or to our 
longing after music or mountains, — and everybody will have 
striking instances at hand — are interpretations of our ner- 
vous irritations during sleep. . . . The fact that this text 
[of our nervous irritations] which, on the whole, remains very 
much the same for one night as for another, is so differently 
commented upon, that reason in its poetic efforts, on two 
successive days, imagines such different causes for the same 
nervous irritations, may be explained by the prompter of 
this reason being to-day another than yesterday, — another 
craving requiring to be gratified, exemplified, practised, re- 
freshed, and uttered, — this very one, indeed, being at its 
flood-tide, while yesterday another had its turn? Real life 
has not this freedom of utterance which dream-life has; 
it is less poetic, less licentious." Our cravings thus, in sleep, 
prompt a fictional and poetic gratification or utterance; 
Nietzsche's expression is very suggestive. 

Sometimes our dreams come true. Our wishes are 
seldom preposterous — inconceivably attainable. "In the 
attempt to realize our dreams," as Mr. Havelock Ellis says, 
"lies a large part of our business in life."^ Where there is a 
will there is a way. In waking reality we work toward and 
sometimes succeed in getting that for which we have longed, 
and of which we have dreamed. Thus the old belief that 
dreams are prophetic is justified. For the belief is indeed 
old and widespread, prevailing among all nations, civilized 
and uncivilized, and leaving traces in all literatures."^ "I 
will pour out my spirit upon all flesh," says the Lord to Joel, 
"and your sons and your daughters shall prophesy, your 
old men shall dream dreams, and your young men shall see 
visions." We may say of prophecy in dreams, as Dr. 
Johnson said of apparitions: "All argument is against it, 

^The World of Dreams, "Aviation in Dreams." 
^See E. B. Tylor, Primitive Culture, index. 



F. C. Prescott 25 

but all belief is for it." We shall see presently that this 
belief is true in a profound sense. ^ 

It will be difficult, however, for various reasons, to give 
examples which will make what has just been said — of wish 
fulfilment and prophecy in dreams — clear and convincing 
to the reader. Actual dreams might easily be recounted, 
and to these might be added the wishes which they have been 
found on analysis really to represent. This, however, 
would be unsatisfactory unless the analysis were also given, 
which is impracticable. The interpretation of dreams is 
difficult, involving knowledge of a complicated technique. 
It does not proceed by a uniform, stereotyped substitution 
of meanings for the dream symbols as in the old quackery 
of the "dream books." Though the general principles of 
interpretation are definitely ascertained, their appli- 
cation in practice varies constantly with the experiences, 
thoughts, and associations of each individual. Thus any 
convincing interpretation of examples would take the reader 
deep into the personal history of the dreamer and would 
involve endless narrative and explanation.^ It, seems better 
for our purpose to take an example from the analogous field 
of waking dreams or "day dreams." When we are alone 
and our attention is abstracted, when we sit with wide- 
open eyes before the fire or gaze through the window 
without seeing, when the pressure of the outside world is 
thus relaxed, then we "dream being awake." Our imagi- 
nations are freed and portray to the mind's eye an ideal 
world in which our hopes, otherwise vain, are realized. 
Then we build castles in Spain, or elsewhere, as we wish. 
If the conditions are favorable, if the imagination is active, 
and if the mind is moved by strong emotion^ these waking 
visions sometimes become extraordinarily vivid, amounting 
to hallucinations. 

The following example, then, will illustrate wish-fulfil- 

See Freud, Sammlung kleiner Schriften zur Neurosenlehre, zweite Folge, p. 
59, on "resolution dreams"; also for dreams actually prophetic, A. A. Brill, New 
York Medical Journal, April 23, 1910. Dr. Brill first clearly explained the mantic 
character of dreams, 

^Plenty of examples will be found in the Traumdeutung and in the summaries 
in the American Journal of Psychology, already referred to. 



26 Poetry and Dreams 

ment and prophecy in dreams. Goethe tells how, as he was 
once riding to Gesenheim after visiting Fredericka he saw 
his counterpart riding toward him. "I saw myself coming," 
he says, "along the same path on horseback toward me, 
dressed, as I had never been, in pike-gray and gold. I 
shook myself out of the dream, and the figure was gone. 
But it is singular that eight years later, not at all by choice, 
but only by chance, I found myself riding over the same 
path in the very direction my visionary self took, and clad 
in just these clothes, being again on my way to Fredericka. 
Whatever the explanation of these things may be, the 
wonderful phantom gave me at that moment of separation 
some alleviation." ^ 

It is noteworthy that Goethe himself speaks of this 
apparition as a dream. The illusion was apparently stronger 
than in the ordinary daydream, perhaps because Goethe's 
imagination was more profound, perhaps because the in- 
citing emotion was more violent. The dream, however, 
is easy of interpretation. In this, as doubtless in all 
hallucinations, the wish is father to the thought. This 
visionary self, going in the opposite direction, obviously 
embodies a desire to return to Fredericka. And this desire 
is actually fulfilled, when eight years later Goethe follows 
the impulse which inspired his dream and returns to Fred- 
ericka, though apparently the impulse did not remain a 
conscious one with Goethe, for he returned by chance and 
not by choice. The dream thus becomes prophetic. Even 
the suit of pike-gray and gold is realized, though this also 
will seem not at all remarkable after a moment's considera- 
tion. Thus dreams always represent wishes, and thus 
dreams sometimes come true. In his pathetic essay," Dream 
Children," Lamb recounts a dream in which one of the 
deepest wishes of his heart secures imaginary gratification; 
but on awaking he finds himself "quietly seated in his 
bachelor armchair," and his wish is never in actuality 
realized. The same wish inspires similar visions in a recent 
tale, "They," by Mr. Kipling. 

Poets have often, if not always, been great dreamers, 
not only metaphorically, but actually, and both by night 

Quoted by Hirsch, Genius, p. 93. 



F, C. Prescott 27 

and by day. Goethe had other strange visions. Lamb, 
for example in his "Chapter on Ears," recounts in his 
quaintly humorous way quite terrible dream experiences. 
Chatterton and Blake had remarkable dreams and visions, 
which were closely connected with their poetry. De Quincey 
found in dreams material for his "impassioned prose." 
Coleridge in sleep composed the beautiful fragment which 
he entitled " Kubla Khan." The "Ancient Mariner " is either 
a dream or like one; as Lowell notes, "it is marvelous in its 
mastery over that delightfully fortuitous inconsequence 
which is the adamantine logic of dreamland." ^ Poe has 
an interesting passage on the "psychal fancies" arising in 
the soul "at those mere points of time where the confines 
of the waking world blend with those of the world of 
dreams"; ^ and " Ligeia " and " Ulalume " give some idea of 
the strange world "out of space, out of time," through 
which his spirit passed. 

Bunyan, who is the type in literature of native inspira- 
tion without culture, and who thus perhaps illustrates with 
special clearness the working of poetic imagination pure and 
untrammeled, constantly beheld visions under the stress 
of his religious emotion. As a child, he tells us, he com- 
mitted terrible sins. These "did so offend the Lord, that 
even in my childhood he did scare and affright me with 
fearful dreams, and did terrify me with dreadful visions."^ 
External objects and events passed by him unnoticed; while 
"he looked upon that which was passing through his own 
mind and heart as though it were something external."^ 
Watching his brazier's fire, journeying alone through coun- 
try roads, working mechanically in Bedford jail, he saw 
images and heard voices which were as clear and vivid to him 
as those of objective reality. Like Dunstan and Luther, he 
was tempted by the Devil in person, and yielded; he re- 
pented, and saw Christ himself looking down at him through 
the tiles of the house-roof, saying, "My grace is sufficient 
for thee." These appearances, says Taine, were "the 
products of an involuntary and impassioned imagination. 

Literary and Political Addresses, "Coleridge." 
^" Marginalia," Works, Virginia edition. Vol. XVI, p. 88. 
'Grace Abounding, ed. Brown, pp. 9, xxiii. 



28 Poetry and Dreams 

which by its hallucinations, its mastery, its fixed ideas, its 
mad ideas, prepares the way for the poet, and announces 
an inspired man."^<^So Bunyan was, as his principal 
biographer styles him, essentially "The Dreamer."^ His 
books are little more than a record of his dreams. "As I 
walked through the wilderness of this world, I lighted on a 
certain place where was a Den, and I laid me down in that 
place to sleep: and, as I slept, I dreamed a dream." Thus 
begins The Pilgrim's Progress, as the title says, "in the 
similitude of a dream. '^ 

^Shelley, the type of inspired poets, exhibited the same 
psychological character. "At no period of his life," says 
J. A. Symonds, "was he wholly free from visions which had 
the reality of facts. Sometimes they occurred in sleep, and 
were prolonged with painful vividness into his waking mo- 
ments. Sometimes they seemed to grow out of his intense 
meditation, or to present themselves before his eyes as the 
projection of a powerful inner impression. All his sensa- 
tions were abnormally acute, and his ever-active imagination 
confused the border lands of the actual and the visionary."^ 
The account, given by Hogg, of his "slumbers resembling 
a profound lethargy," tells us that ''he lay occasionally upon 
the sofa, but more commonly stretched out before a large 
fire, like a cat; and his little round head was exposed to such 
a fierce heat, that I used to wonder how he was able to bear 
it. . . . His torpor was generally profound, but he would 
sometimes discourse incoherently for a long time in his 
sleep." Then "he would suddenly start up, and, rubbing 
his eyes with great violence, and passing his fingers swiftly 
through his long hair, would enter at once into a vehement 
argument, or begin to recite verses, either of his own com- 
position or from the work of others, with a rapidity and an 
energy that were often quite painful."* Curiously this 
bodily heat was with Shelley conducive to dreams and 
poetry ."- The " Cenci " was written in the warm sun on his 

English Literature, Book II, Chap. 5, Sec. 6. 
^See, for example, the vision described in Grace Abounding, paragraph 53, 
with Bunyan's interpretation. 
=> Shelley, p. 91. 
^Shelley, p. 30. 



F. C. Prescott 29 

roof at Leghorn.^ "When my brain gets heated with a 
thought," he said, "it soon boils." ^ In such a mood he 
wrote " The Triumph of Life." "The intense stirring of his 
imagination impUed by this supreme poetic effort, the soli- 
tude of the Villa Magni, and the elemental fervor of Italian 
heat to which he recklessly exposed himself, contributed to 
make Shelley more than usually nervous. His somnam- 
bulism returned, and he saw visions. On one occasion 
he thought that the dead Allegra rose from the sea, and 
clapped her hands, and laughed and. beckoned to him. On 
another he roused the whole, house at night by his screams, 
and remained terror-frozen in the trance produced by an 
appalling vision."^ A study of Shelley's life shows that 
there is the closest connection between this power of vision 
and his poetical faculty. Perhaps Shelley's case was one of 
those which led Lamb to believe that the soul's creativeness 
in sleep furnishes a measure of the poetical faculty. 

Stevenson has a "Chapter on Dreams," describing his 
own experience, which is so instructive that if space per- 
mitted it should be quoted here entire."^ "He was from a 
child," he tells us, "an ardent and uncomfortable dreamer"; 
as a child he had terrible dream-haunted nights. While a 
student in Edinburgh he b^gan "to dream in sequence, and 
thus to lead a double life — one of the day, one of the night" 
— which soon sent him "trembling for his reason" to the 
doctor. He "had long been in the custom of setting himself 
to sleep with tales, and so had his father before him." It is 
not strange, then, that he "began to read in his dreams — 
tales, for the most part, and for the most part after the 
manner of G. P. R. James, but so incredibly more vivid 
and moving than any printed books, that he has ever since 
been malcontent with literature." "But presently," he 
continues, "my dreamer began to turn his former amuse- 
ment of story telling to (what is called) account; by which 
I mean that he began to write and sell his tales. Here 
was he, and here were the little people who did that part 

^E. Dowden, Life' of Shelley, p. 429. 

"Symonds, Shelley, p. 166; see quotation, p. 40, below. 

Ubid., p. 177. 

*Works, Thistle Edition, Vol. XV, p. 250. 



30 Poetry and Dreams 

of his business, in quite new conditions. The stories must 
now be trimmed and pared and set upon all fours, they must 
run from a beginning to an end and fit (after a manner) with 
the laws of life; the pleasure in a word had become a business; 
and that not only for the dreamer but for the little people 
of his theatre. These understood the change as well as he. 
When he lay down to prepare himself for sleep, he no longer 
sought amusement, but printable and profitable tales; and 
after he had dozed off in his box-seat, his little people con- 
tinued their evolutions with the same mercantile designs." 
Thus the scenes of some of Stevenson's tales, for instance 
of *'Dr. Jekyll and Mr. Hyde," were first enacted in this dream 
theatre; and these tales were, as he represents them, a col- 
laboration between himself and what he calls his "little 
people" — that is, between his conscious waking intellect 
and his dream faculty. 

These examples will perhaps serve to make more con- 
vincing the transition which we are now to make from dreams 
to poetry proper. The function of poetry also seems to be to 
represent the imaginary fulfilment of our ungratified wishes 
or desires. The poet Bacon says, "submits the shows of 
things to the desires of the mind." The poet is essentially 
a man filled with desire, unsatisfied; and it is in a state of 
dissatisfaction that poetry arises.^ The lover, separated 
from his mistress, who falls to scribbling verses, is typical 
of all poets. The dissatisfaction inspiring poetry, however, 
may be of any kind. Burns parted from his Clarinda, 
Dante worshiping Beatrice from a distance, Byron suflFering 
from oppression and unable to fight actively against it, 
Coleridge dissatisfied with life in England, as he finds it, and 
dreaming of a Utopia on the banks of the Susquehanna, 
Wordsworth looking back to the time when the earth 
"did seem 
Apparelled in celestial light," 

are all in the mood for producing poetry. The poet does not 
live in the present; he hopes and aspires, ^'ll is no mere 
appreciation of the beauty before us," says Poe, which in- 
spires the poet, "but a wild effort to reach the beauty 

Compare the theory of Ribot, L'Imagination Creatrice, p. 36; "C'est dans 
les besoins qu'il faut chercher la cause premiere de toutes les inventions." 



F. C. Prescott • 31 

above. It is the desire of the moth for the star.' The 
use of poetry is to aflFord an escape from reality; to trans- 
form the real world, by an effort of the poetic imagination, 
into an ideal world in accordance with our desires, our hopes, 
our aspirations. The use of poetry, Bacon says again, *^ 
"hath been to give some shadow of satisfaction to the mind 
of man in those points wherein the nature of things doth \y 
deny it; the world being in proportion inferior to the soul; 
by reason whereof there is agreeable to the spirit of man a 
more ample greatness, a more compact goodness, and a more ^ 
absolute variety, than can be found in the nature of things. "^ 
Byron expresses nearly the same thought in verse: 

" The beings of the mind are not of clay; 

Essentially immortal, they create 
And multiply in us a brighter ray 

And more beloved existence: that which Fate 

Prohibits to dull life, in this our state 
Of mortal bondage, by these spirits supplied, 

First exiles, then replaces what we hate; 
Watering the heart whose early flowers have died, 
And with a fresher growth replenishing the void."^ 

It is perhaps dangerous to generalize broadly and say 
that the use of all poetry is that which Bacon describes, 
that poetry uniformly represents the gratification of unsat- 
isfied desires. Much goes under the name of poetry, satir- 
ical, humorous, and didactic, to which this description is 
not directly applicable. Poetry is broadly of two kinds — to 
employ a distinction of John Keble's which will be noticed 
later — primary, which is original and inspired, and sec- 
ondary, which is second-hand, copying the forms of in- 
spiration. There is Homer, and there are poets like those 
whom Plato describes as depending on Homer, as the suc- 
cessive iron rings on the magnet. Our principle applies 
only to the poetry of inspiration. Perhaps an imaginative 
lyric of pure joy would constitute an exception to the prin- 
ciple. It is doubtful, however, if unmixed joy is a poetical 
mood; if the note of sadness is not, as Shelley and Poe 

The Poetic Principle." 
''The Advancement of Learning, Book II. 
'Childe Harold's Pilgrimage, IV, 5. 



32 • Poetry and Dreams 

thought, inseparable from true poetry. Perhaps even in 
joy the heart remains unsatisfied; "it may still feel," as Poe 
says, "a petulant impatient sorrow at our inability to grasp 
now, wholly, here on earth, at once and forever, those divine 
and rapturous joys of which ... we attain to but brief 
and indeterminate glimpses."^ Poetry, according to Words- 
worth and Coleridge, always implies passion; and passion is 
properly suffering, dissatisfaction, the effect of desire. "Most 
wretched men," says Shelley, in "Julian and Maddalo," 
"Are cradled into poetry by wrong: 
And learn in suffering what they teach in song." 

Poetry expresses passion, and poetry expresses unsatis- 
fied desire; I believe it is not psychologically incorrect to say 
that these two statements are fundamentally equivalent. 

In judging the general principle above mentioned — that 
the end of poetry, as of dreams, is to satisfy desire — the reader 
should keep in mind two further considerations. First, 
that the gratification of poetry may extend no further than 
that derived from the idealized expression, which is in every 
case substituted for the imperfect and inhibited utterance 
of ordinary life. Secondly, that in poetry the poet's de- 
sires are not represented openly and literally; they are dis- 
guised, conveyed through a medium of fiction, bodied forth 
in strange forms as a result of the alchemic action, the 
"dream- work," of the poet's brain. The last point will be 
more ful'.y considered later. 

The poet is called creative, and his activity that of 
the creative imagination. "God without any travail to his 
divine imagination," says Puttenham, expressing the view of 
the older English critics, " made all the world of naught. . . . 
Even so the very poet makes and combines out of his own 
brain both the verse and matter of his poem."^ So Byron 
says of poetry: 

" 'Tis to create, and in creating live 
A being more intense, that we endow 
With form our fancy, gaining as we give 
The life we image, even as I do now."^ 

"The Poetic Principle." 
'^Arte of English Poesie, ed. Arber, p. 19. 
"Childe Harold's Pilgrimage, III, 6. 



F. C. Prescott 33 

And Shelley of the poet: 

"But from these create he can 
Forms more real than living man, 
Nurslings of immortality."^ 

The poet is called a creator because, as we have seen, he 
creates in an ideal world, according to our desires, what is 
lacking in the divinely created world of reality. His work 
is thus akin to the divine — "a repetition," as Coleridge 
calls it, "in the finite mind of the eternal act of creation 
in the infinite / am.'^^ He is essentially what the name 
signifies, TrotT^r?;?, a maker or creator. Poetry, as all the 
older and better critics agree, is not essentially expression 
in metrical language, — 

*'No jingling serenader's art 
Nor tinkling of piano strings."^ 

Bacon, following Aristotle, calls poetry "feigned history," 
and includes under it all kinds of fiction. "The poet is 
a maker, as his name signifies," says Dryden, "and he who 
cannot make, that is, invent, has his name for nothing." 
Fiction, moreover, is essentially equivalent to poetry, as its 
etymology would suggest — coming from the Latin fingere, 
related to facere, it signifies a making or creation.* The 
German Dichtung comprises both poetry and fiction; indeed, 
by older English critics plays and novels are frequently 
called poems, even when written in prose. The essential 
activity of the writer of plays and novels is the same as that 
of the poet; he also creates in an ideal world, subjecting the 
shows of things to the desires of the mind. The word 
poetry, therefore, will be used here throughout, as the 
equivalent of Dichtung^ to include every work of creative 
imagination in literature, whether in prose or verse. 

The poets have traditionally been considered prophets. 

Prometheus Unbound, Act I, Sc. 1. 

^Biographia Literaria, Chap. XIII. 

'Emerson, Merlin. 

*To this creation the imitation of Aristotle is essentially equivalent. It is 
not an imitation of nature in the ordinary sense, but a sublimation of nature; or, 
more exactly, a mimic creation, arising partly from the natural propensity of men 
to copy what they see in nature, and partly from the poetic or fictioning propensity 
mentioned above. See S. Butcher, Aristotle's Theory of Poetry and Fine Art, 
Chap. IV, particularly pp. 150, 153. 



34 Poetry and Dreams 

Apollo was the god of poetry and of the* oracles. "The 
oracles of Delphos and Sibylla's prophecies were wholly 
delivered in verses"; as those of Mother Shipton and of the 
present day fortune-teller are in jingling rhymes. The same 
is true "of the dreamer Merlin and his prophecies." To the 
bard, the seer, and the prophet have been attributed the 
same character and inspiration. This view is still confidently 
held. After noting that in earlier epochs poets were called 
legislators and prophets, Shelley says: "A poet essentially 
comprises and unites both of these characters. For he 
not only beholds the present intensely as it is and discovers 
the laws according to which present things ought to be 
ordered, but he beholds the future in the present, and his 
thoughts are the germs of the flower and fruit of latest time." 
Emerson believes that poets are still inspired to prophecy, — 
as in "Merlin": 

"There are open hours 
When the God's will sallies free 
And the dull idiot might see 
The flowing fortunes of a thousand years." 

What is the explanation of this union of poetry and 
prophecy.^ Perhaps in part it lies merely in the fact that the 
poet is a man of wide learning and observation, of free and 
comprehensive thought, who, employing an imagination of 
the merely practical order, akin to that of the merchant 
forecasting the coming year in business, "beholds the future 
in the present" and foretells it. Thus Shelley foresaw 
future events in Irish politics.^ A deeper explanation is 
suggested, however, by the apparition of Goethe, men- 
tioned above. The poet in his poetry expresses his desires, 
primarily his own desires, but also, through his well-known 
universal and representative character, the desires of others 
— of his class or country, of mankind. Great poets are 
great for that reason, because their writings give "some 
shadow of satisfaction" to the minds of all men. What the 

^Symonds, Shelley, pp. 62, 63. Shelley had strange premonitions of his 
deathbydrowning; see p. 154. Blake, taken by his father to Ryland's studio, said, 
after leaving, "Father, I do not like the man's face; it looks as if he will live to 
be hanged" — which he was, twelve years later. See Gilchrist's Life, Vol. I, 
p. 13. Perhaps we had better leave such strange prophecies unexplained. 



F. C. Prescott 35 

great poet desires all men desire; he is only their spokesman. 
And what all men desire they strive earnestly to obtain, and 
will obtain eventually. As Lowell says, 

"The dreams which nations dream come true, 
And shape the world anew."^ 

Thus the connection between poetry and prophecy becomes 
at least partially explicable and comprehensible to us. It 
is no marvel if in this way the poet sees "the flowing fortunes 
of a thousand years." The range of prophecy is as great as 
that of human desire or aspiration. For example, "The 
kingdom of heaven is like to a grain of mustard seed, which 
a man took, and sowed in his field; which is indeed the least 
of all seeds: but when it is grown it is the greatest 
among herbs, and becometh a tree, so that the birds of the 
air come and lodge in the branches thereof." This, though 
not to be definitely interpreted, is poetry and prophecy — a 
prophecy which apparently has required and will require 
great length of time for its fulfilment. Even the beautiful 
vision of John, who was carried away in the spirit and saw a 
great city, the street whereof was pure gold, as it were trans- 
parent glass, will one day, let us all hope, be realized. 

"Among the Romans a poet was called vates, which is as 
much as a diviner, foreseer, or prophet, as by his conjoined 
words, vaticinium and vaticinari, is manifest; so heavenly a 
title did that excellent people bestow upon this heart- 
ravishing knowledge."^ The poet, the prophet, and the 
priest are one, because the best of religion is prophecy and 
poetry of the highest kind. The true priest sees truth 
by subjecting the shows of things to the desires of the 
mind — to our highest desires or aspirations. The true 
priest, as we shall see presently, like the poet, also ministers 
to the peace and comfort of mankind. At the present time, 
when prophecy is no longer believed in, when poetry is too 
often regarded as mere versifying or artistry, and when 
religion is so much in need of inspired ministers, it will help 
us to recognize the common character in these three things, 
which the men of old wisely joined together and which we 
have put asunder. 

"Ode to France." 

''Sidney, Defense of Poesy, ed. Cook, p. 5. 



36 Poetry and Dreams 

II 

Poetry, then, like dreams, affords expression and 
imagined gratification to our desires. If our desires are 
actually gratified, our poetry, like our dreams, becomes 
prophetic. The explanation is in both cases the same. Let 
us follow the parallel further. 

Dreams, according to Dr. Freud, are not, excepting 
those of children, inspired by conscious desires, but by 
unconscious ones.^ Sometimes, it is true, the manifest 
content of a dream shows without distortion the fulfilment 
of a wish of which the dreamer is entirely conscious; more 
often also such a conscious wish is discovered in the latent 
content on analysis; in every case, however, as appears 
on fuller analysis, these conscious wishes are associated 
with and merely re-enforce deeper unconscious ones, which 
are the fundamental motives to the dream activity. Thus 
no wish is capable of producing a dream which is not un- 
conscious or associated with another wish which is uncon- 
scious. This, for its explanation, requires some knowledge 
of a part of Dr. Freud's psychological theory which is funda- 
mentally important, namely, that which deals with psychic 
repression. Only such desires remain in our consciousness 
as are "acceptable to consciousness." Certain desires 
cannot possibly be gratified because they meet with actual 
external hindrances. Others cannot be gratified because 
their gratification would be incompatible with our duty — 
our obligations towards others. In either instance there is 
a conflict between the selfish individual impulse and ob- 
jective circumstances — environment; the case being the 
same whether the hindrance to gratification is physical, 
lying in an actual impediment, or moral, arising from the in- 
dividual's regard for law, morality, custom, or the opinion 
of others. Such desires, since they are incapable of being ex- 
pressed in activity calculated to secure gratification, are 
not worth retention in consciousness. They are, moreover, 
inevitably unpleasurable — painful to the individual, and 

Dr. Freud uses the term unconscious to denote mental processes which cannot 
spontaneously be recalled to consciousness, — which are recalled only under 
unusual circumstances or by artificial means. For the theory of this section see 
Die Traumdeutung, VII. 



F. C. Prescott 37 

because painful, they are by a defensive process, repressed. 
These desires, however, are still proper to the individual; 
they are not removed, but only transferred to unconscious- 
ness; and there remain operative. That is, they are still 
capable of starting various mental processes. One of these 
processes is that of dreams. Our unconscious wishes — those 
which are impracticable, or which are painful, shameful, or 
otherwise intolerable, and thus are driven from our conscious 
waking minds — are fulfilled for us in sleep. And biologi- 
cally considered, the function of dreams is this, — that they 
satisfy and allay mental activities which otherwise would dis- 
turb sleep. By affording a necessary expression or discharge 
they secure mental repose. The dream is thus the "guardian 
of sleep." The function of day dreams and hallucinations is 
doubtless the same — to relieve the overburdened mind 
and secure a comfort not to be found in the presence of 
reality.^ Speaking of the apparition already mentioned, 
Goethe says: "Whatever the explanation of these things 
may be, the wonderful phantom gave me at that moment of 
separation some alleviation." 

Some readers may be inclined to doubt the existence 
of this repression, of unconscious desires, and in general 
of the "unconscious" which plays so large a part in Dr. 
Freud's theory. They may be inclined to believe that a 
person is definitely aware at any moment what his desires 
are, and his motives for action; and that unconscious de- 
sires and motives are a fiction. Such a belief is, as we shall 
see in a moment, strongly opposed by the best evidence in 
literature. : "The uttered part of a man's life," as Carlyle'^ 
observes, "bears to the unuttered unconscious part a small 
unknown proportion; he himself never knows it, much 
less do others."^ 

If poetry then, as we have seen, like dreams, has for 
its purpose the imaginary gratification of our desires, it 
also, like dreams, proceeds from an unconscious rather than 
a conscious mental activity, and has its origin in uncon- 
scious sources. Poetry is not produced by the poet spon- 
taneously, by a voluntary action of the intellect; it emerges 

Cf. Die Traumdeutung, p. 304. 
^Essays, "Sir Walter Scott." 



38 Poetry and Dreams 

involuntarily and unconsciously as the result of a hidden 
activity, which, therefore, we cannot readily investigate, and 
which we call, without attaching definite meaning to the 
words, that of the "poetic imagination." Poetry, as Shelley 
declares, is "created by that imperial faculty whose throne 
is curtained within the invisible nature of man."^ The 
attitude of the poet is never that of the man of science, 
who can trace his work definitely step by step from in- 
ception to completion; it is rather that of Voltaire, who, 
on seeing one of his tragedies performed, exclaimed, "Was 
it really I who wrote that?" The testimony of poets and 
critics to this effect is universal and familiar to every student 
of literature. It seems advisable, however, to quote from 
some of them. 

^' "Many are the noble words in which poets speak con- 
cerning the actions of men," Plato makes Socrates say, "but 
.... they do not speak of them by any rules of art; they 
are simply inspired to utter that to which the Muse impels 
them. . . . God takes away the minds of poets, and uses 
them as his ministers, as he also uses divines and holy 
prophets, in order that we who hear them may know them 
to be speaking not of themselves who utter these priceless 
words in a state of unconsciousness, but that God himself 
is the speaker, and that through them he is conversing with 
us."^ According to Spenser, poetry is "no art, but a divine 
gift and heavenly instinct, not to be gotten by labor and 
learning, but adorned with both, and poured into the witte 
by a certain Enthousiasmos or celestiall inspiration."^ The 
imagination, on the authority of Shakespeare, "bodies forth 
the forms of things unknown."* 

The expressions of more recent poets and critics are 
to the same effect. This "instinct of the imagination," 
says Hazlitt, "works unconsciously like nature, and receives 
its impressions from a kind of inspiration.^ Scott, the 

^Defense of Poetry, ed. Cook, p. 7. 
^lon, Jowett's Translation, third edition. Vol. I, p. 502. 

''Quoted with part of the preceding, by Woodberry, The Inspiration of Poetry, 
p. 2. 

^Midsummer Night's Dream, Act V, Sc. 1. 
^English Comic Writers, ed. W. C. Hazlitt, p. 147. 



F. C. Prescott 39 

• 
sanest of poets, says: "In sober reality, writing good verses 
seems to depend upon something separate from the voli- 
tion of the author."^ George Eliot, living in the clear 
light of modern science, declared "that in all she considered 
her best writing there was a *not herself which took pos- 
session of her, and that she felt her own personality to be 
merely the instrument through which this spirit, as it 
were, was acting. "^i/ Goethe says: "There is a sense in 
which it is true that poets, and indeed all true artists must 
be born and not made. Namely, there must be an inward 
productive power to bring the images that linger in the or- 
gans, in the memory, in the imagination, freely without 
purpose or will to life." This is the opinion of those we 
should call poets of art as well as of poets of inspiration. 
"It is not well in works of creation," Schiller writes, "that 
reason should too closely challenge the ideas which come 
thronging to the doors. ... In a creative brain reason has 
withdrawn her watch at the doors, and ideas crowd in pell- 
mell."^ Voltaire wrote to Diderot: "It must be confessed 
that in the arts of genius instinct is everything. Corneille 
composed the scene between Horatius and Curiatius just 
as the bird builds its nest."* 

Voltaire's expressive figure agrees curiously with that 
in Emerson's "Problem," which with "Spiritual Laws" throws 
much light on this subject: 

"Know'st thou what wove yon woodbird's nest 
Of leaves, and feathers from her breast? 
Or how the fish outbuilt her shell, 
Painting with morn her annual cell.'' 

"The hand that rounded Peter's dome 
And groined the aisles of Christian Rome 
Wrought in a sad sincerity: 
Himself from God he could not free; 
He builded better than he knew; — 
The conscious stone to beauty grew. 

^Lockhart, Life of Scott, Chap. XXXVIII, Letter to Lady L. Stuart. 
'^Cross, Life of George Eliot. 
'Quoted by Hirsch, Genius, pp. 31-33. 
'April 20, 1773. 



40 Poetry and Dreams 

• 
** These temples grew as grows the grass; 
Art might obey, but not surpass. 
The passive Master lent his hand 
To the vast soul that o'er him planned." 

We may stop a moment more over two writers whom we 
have already considered in some detail — Bunyan and 
Shelley. Taine writes of Bunyan's imagination: ^'Powerful 
as that of an artist, but more vehement, this imagination 
worked in the man without his co-operation, and besieged 
him with visions which he had neither willed nor foreseen. 
From that moment there was in him, as it were, a second self, 
ruling the first, grand and terrible, whose apparitions were 
sudden, its motions unknown, which redoubled or crushed 
his faculties, prostrated or transported him, bathed him in 
the sweat of agony, ravished him with trances of joy, and 
which by its force, strangeness, independence, impressed 
upon him the presence and the action of a foreign and 
superior master."^ 

Shelley's inspiration must have been of a similar order. 
Trelawny tells of finding Shelley alone one day in a wood 
near Pisa, with the manuscript of one of his lyrics: "It was 
a frightful scrawl, words smeared out with his fingers, and 
one upon another, over and over in tiers, and all run to- 
gether in the most admired disorder. . . . On my observing 
this to him, he answered, 'When my brain gets heated with 
a thought, it soon boils, and throws off images and words 
faster than I can skim them off. In the morning when cooled 
down, out of the rude sketch, as you justly call it, I shall 
attempt a drawing. ' "^ '^ We have seen that with Shelley 
bodily heat was conducive to dreams and poetry. -^So here 
he describes the heat of inspiration; as he does also in the 
following from the Defense of Poetry: "Poetry is not like 
reasoning, a power to be exerted according to the determi- 
nation of the will. A man cannot say, 'I will compose 
poetry.' The greatest poet even cannot say it; for the mind 
in creation is as a fading coal, which some invisible influence, 
like an inconstant wind, awakens to transitory brightness; 
this power arises from within, like the color of a flower 

English Literature, Book II, Chap. V, Sec. 6. 
'^Symonds, Shelley, p. 166. 



F. C. Prescott 41 

which fades and changes as it is developed, and the conscious 
fortunes of our natures are unprophetic either of its approach 
or its departure. "^^ 

Poetical creation, then is generally described as an in- 
stinctive and unconscious process. Poetry is not a con- 
scious product of the intellect, but the manifestation or 
symptom of an inner uncontrolled activity. What does 
this mean? We have seen that poetry is the expression of 
desires. Is it not natural to suppose that the desires of the 
poet, as of the dreamer, are impeded and consequently re- 
pressed, — forced back into unconsciousness. These desires 
are prevented from serving as motives for conscious action 
looking toward gratification; thus failing of expression they 
become unconscious but still remain operative in another 
manner — that is, in starting an activity affording a fictional 
gratification. If this is the case then poetry, like dreams, has 
its source in repressed and unconscious desires. Let us see 
what further support is to be found in literature for this view. 
^ In one of his critical essays, which has been too much 
overlooked, John Keble "proposes by way of conjecture" 
the following definition: "Poetry is the indirect expression 
in words, most appropriately in metrical words, of some 
overpowering emotion, ruling taste, or feeling, the direct 
indulgence whereof is somehow repressed."^ ix'Keble's exposi- 
tion of this definition is well worth the reader's attention. 
As a whole it cannot be even summarized here. Some parts 
of it, dealing with the nature of the poet's indirect ex- 
pression, with the function of metre, and with the kinds of 
poetry, will be noticed later. For the present we are con- 
cerned with Keble's theory of repression in poetry — which 
is in substance that poetry is the expression of repressed 
emotion, or, • substituting terms which he uses on another 
page, of repressed "desire or regret."^ Keble says nothing 
of the unconscious origin or production of poetry; other- 
wise his theory is obviously in general agreement with that 

^The British Critic, Vol. XXIV, p. 426, — a review of Lockhart's Life of 
Scott, reprinted in Occasional Papers and Reviews, 1877. See also Keble's De 
Poeticae Vi Medica; Praelectiones Academicae Oxonii Habitae, 1844. 

^Keble's theory is founded on Aristotle's; cf. ibid., pp. 428, 435. He per- 
haps does some violence to Aristotle's imitation in translating it expression; but 
his theory is in substantial agreement with Aristotle's. 



42 Poetry and Dreams 

suggested in the preceding pages. There is no element of 
poetry in the direct indulgence, or expression, of feeling. 
It is only when this indulgence, or expression, is impeded 
that poetry arises. Thus a speech which contrives by as- 
sociation or allusion to expose a hidden feeling, or a face 
which by a sudden and fleeting play of feature conveys an 
otherwise incommunicable motion of the heart, we feel to be 
"expressive," or "poetical." It gives pleasure by over- 
coming difficulty and obviating repression. We call a land- 
scape poetical "when we feel that it answers, or tends to 
express, and by expression to soothe or develop, as the case 
may be, some state more or less complicated of human 
thought and feeling," for which we can find no words. 
Poetry expresses what by other means is inexpressible. 
The impediment to expression may be of any nature. Per- 
haps the "very excess and violence" of the emotions "make 
the utterance of them almost impossible"; perhaps the 
emotions "in their unrestrained expression would appear 
too keen and outrageous to kindle fellow feeling"; perhaps 
there is in the writer's mind an "instinctive delicacy" which 
shrinks from communication. In any case direct expression 
being impossible a veiled or poetical one is the recourse. 

For some expression is necessary; the emotions must 
have vent. What Keble calls "the instinctive wish to 
communicate" must be satisfied.^ "All men," Emerson 
says, "live by truth, and stand in need of expression. In 
love, in art, in avarice, in politics, in labor, in games, we study 
to utter our painful secret. The man is only half himself, 
the other half is his expression."^ Thus to "open one's 
mind" is healthful and comforting. The lover is relieved 
if he can confess his passion. The man in anger must 
"speak his mind" or "have it out." And the same in 
grief; "he often finds present helpe who does his griefe 
impart."^ On the other hand, the repression of emotion 
is painful and dangerous. "That way madness lies." 
"Give sorrow words: the grief that does not speak, 
Whispers the o'erfraught heart and bids it break."* 

See Hirsch, Genius, pp. 43-45. 
"Essays, "The Poet." 
'Spenser, Faerie Queene, II, i, 46. 
^Macbeth, Act IV, Sc. 3. 



F. C. Prescott 43 

This helps to explain the cause and use of poetry. We 
have seen that the function of dreams is to prevent the 
disturbance of sleep; that of poetry is entirely analogous. 
"Here, no doubt," says Keble, "is one final cause of poetry: 
to innumerable persons it acts as a safety valve, tending to 
preserve them from mental disease." Or, as Newman 
expresses it: "Poetry is a method of relieving the over- 
burdened mind; it is a channel through which emotion finds 
expression, and that a safe, regulated expression." It ac- 
complishes "thus a cleansing,^' as Aristotle would word it, 
"of the sick soul."' 

The testimony of poets supports this view. Goethe 
speaks of his habit "of converting whatever rejoiced, or 
worried or otherwise concerned me into a poem and so have 
done with it, and thus at once to correct my conception of 
outward things and to set my mind at rest." "Sing I 
must," he makes Tasso say, "else life's not life." Schiller, 
speaking of some of his lyrics, says: "They are too true for. 
the individual to be called poetry proper; for in them the 
individual appeases his need and alleviates his burden."^ 
"I kittle up my rustic reed," says Burns in his Epistle to 
W. Simson, "it gies me ease"; and to the same effect 
in a letter to Moore: "My passions raged like to many 
devils till they got vent in rhyme; and then conning over my 
verses, like a spell, soothed all into quiet."^ Wordsworth 
must have found relief in poetical expression: 

"To me alone there came a thought of grief; 
A timely utterance gave that thought relief, 
And I again am strong."^ 

^Essays Critical and Historical, "John Keble." 
^Quoted by Hirsch, Genius, pp. 45, 50. 
^August 2, 1787. Cf . also "The Vision" : 

"I taught thee how to pour in song, 
To soothe thy pain." 
^"intimations of Immortality." Cf . Tennyson, "in Memdriam," v, 2 : 
" But for the unquiet heart and brain, 
A use in measured language lies; 
The sad mechanic exercise, 
Like dull narcotics numbing pain." 
But this is a relief of another sort, — mechanic rather than truly poetic. 



44 Poetry and Dreams 

Mr. Kipling seems to have understood this matter. In- 
troducing the tale of the "Phantom Rickshaw" and speaking 
of its supposed narrator, he says: "When he recovered I 
suggested that he should write out the whole affair from be- 
ginning to end, knowing that ink might assist him to ease 
his mind. When little boys have learned a new bad word 
they are never happy until they have chalked it upon a door. 
And this also is literature."^ The little boy clearing his 
mind by expression is, as Mr. Kipling suggests, typical of the 
later poet. 

This use of poetry to the poet explains, in part at least, 
its value to the reader. The poet provides expression 
not merely for himself, but, by virtue of his representative 
character, for his readers as well. One who reads, not as a 
student or a connoisseur for an ulterior purpose, but for the 
true pleasure and satisfaction which the reading affords, 
finds in poetry the expression not of another's feeling but 
of his own. He identifies himself with the poet and himself 
lives through the poem; the poet is only his spokesman, 
providing him with the needed outlet for his pent emotion; 
for him, too, the poem expresses what would otherwise re- 
main inexpressible. Thus countless readers find relief and 
comfort in poetry. And this explains, in part at least, the 
pleasure which poetry affords. It is a pleasure of satisfied 
desire, akin to the pleasure of actual satisfaction, — the 
satisfaction in this case being an imaginary or fictional one, 
a substitute for the actual, but affording a similar pleasure. 
The use of poetry. Bacon says, is "to give some shadow of 
satisfaction to the mind of man in those points wherein the 
nature of things doth deny it." 

The reader will remember that we are throughout em- 
ploying the term poetry broadly to include all creative liter- 
ature: what has just been said therefore applies to fiction 
generally, to the novel and the drama. Men are fatigued 
with the business of life, they are preyed upon by unpleasant 
feelings, they suffer from a tension which requires relaxa- 
tion. They read a novel or go to the theatre, and find sup- 
plied in fiction what is wanting to them in reality. They 

Kipling omits the last two sentences in some editions of the "Phantom Rick- 
.shaw." 



F. C. Prescott 45 

feel what Keble calls the vis medica poeticce; after living 
in this world of fiction they 

"With peace and consolation are dismissed 
And calm of mind, all passion spent. "^ 

This view of poetry as a safe and regulated expression 
for emotion will perhaps supply some commentary to Aris- 
totle's definition of tragedy. The function of tragedy, 
according to this definition, is "to effect through pity and 
fear the katharsis or purgation of these emotions." This 
definition is not necessarily inconsistent with our description 
of poetry as satisfying desire. Shelley observes: "Sorrow, 
terror, anguish, despair itself, are often the chosen expres- 
sions of an approximation to the highest good. Our sym- 
pathy in tragic fiction depends upon this principle: tragedy 
delights by aflFording a shadow of that pleasure which ex- 
ists in pain."^ The Aristotelian katharsis, at any rate, is 
related to the vis medica which, we have explained. It is not 
a moral but primarily a psychic cleansing, or curative pro- 
cess, aimed at a pathological condition of the mind. Katharsis 
is a medical term; in "the language of the school of Hip- 
pocrates it strictly denotes the removal of a painful or dis- 
turbing element from the organism, by the elimination of 
alien matter."^ "Applying this to tragedy," says Pro- 
fessor Butcher, "we observe that the feelings of pity and 
fear in real life contain a morbid or disturbing element.^ 
In the process of tragic excitation they find relief, and the 
morbid element is thrown off. The curative or tran- 
quilizing influence that tragedy exercises follows as an im- 
mediate accompaniment of the transformation of feeling." 
Thus to the Greeks a dramatic representation was not merely 
a means of amusement, but a great public and sacred rite of 
purification.^ 

Milton, Samson Agonistes, last two lines. 

^Defense of Poetry, ed. Cook, p. 35. 

^Butcher, Aristotle's Theory of Poetry, p. 253. 

^Students of Dr. Freud's theory will understand why fear should contain a 
morbid or disturbing element, — fear being the conversion of repressed desire. 

^This, however, is an unguarded statement. For it is also one purpose of our 
amusements to cleanse the sick mind. Play is the idealizing fiction of the child 
as poetry is of man. It is appropriate, therefore, that we should call our dramatic 
performances plays. 

It is interesting to find that those who practise the method originated by Dr. 



46 Poetry and Dreams 

The conclusion, then, to which this evidence leads is 
that poetry is the expression of repressed and unconscious 
desires; and that the function of poetry, biologically con- 
sidered, like that of dreams, is to secure to us mental repose 
and hence health and well-being. Poetry "cleanses the 
sick soul." Might this be one reason why Apollo had for 
his province not only poetry but healing, the two things 
being thus intimately related as means to end.^ 



Freud, for dealing with psychoneuroses, speak of it as the cathartic method. The 
essential feature of this method is that it provides expression for repressed emo- 
tions, these constituting "a painful and disturbing element in the organism"; it 
effects "the elimination of alien matter." This mere expression has been found 
curative in psychoneuroses. The Greeks were apparently familiar with a cathartic 
treatment for morbid emotional states, persons afflicted with madness or "enthu- 
siasm" being treated by music, which accomplished an emotional cleansing analo- 
gous to that accomplished by tragedy. Persons so treated, says Aristotle, "fall 
back into their normal state, as if they had undergone a medical or purgative 
treatment." Perhaps this is one of the matters which the Greeks understood 
better than we. See Butcher. Aristotle's Theory of Poetry, Chap. IX; cf. Plato, 
Charmides, Jowett's translation, third edition, Vol. I, p. 13. 

{To he concluded) 



PRELIMINARY NOTE ON THE PHYSIOGNOMICAL 

REFLEX 

BY SMITH BAKER, M.D., UTlCA, N. Y. 

IN a paper prepared for the New York State Medical 
Society for the year 1903, I first made use of the term 
"Physiognomical Reflex," but in a way so hesitant 
and tentative that even for myself it had but an 
indifferent interest, more curious than useful, and was 
subsequently erased as being too inconsequential for further 
use. However, it proved to be the starting point of an in- 
vestigation which more recently has become increasingly 
interesting and useful, and which, seemingly, promises 
something that will be worth while in the future. 

When one thinks of it, everybody makes practical 
use of the automatic expressions of the face, in all his 
associations with his fellows. Not only do we thus con- 
sciously or unconsciously obtain much of the information 
on which we base our estimation of character in its entirety, 
but likewise certain very definite grounds for our specific 
dealings with people, whether these be merely of temporary 
significance or more lasting. In this way, too, every item 
of domestic or social or business, or other experience, gets 
to be more or less modified by the impressions that we get 
from people's faces. 

Nor does the use of this method of " reading" the mental 
and allied possibilities of individuals stop with the common 
affairs of daily life. Every educator, clergyman, lawyer, 
detective, physician, and likewise every one else who has 
significantly to do with people in particular ways, knows that 
to a very great extent success depends upon ability to ac- 
curately "read" the revelations of people's faces, almost 
more than upon any other one qualification. As for the 
physician, especially, he all along makes so much use of his 
appreciation of the characteristic "facies" belonging to 
certain diseases, as well as of many more or less crude or 
refined appreciations of the variable physiognomies ob- 
served in health, to help him both in diagnosis and prog- 
nosis, that he is generally convinced that reliance upon 

47 



48 Preliminary Note on the Physiognomical Reflex 

what he perhaps but intuitively gleans in this quiet way 
often stands him in better stead when he enters upon his 
course of management of certain cases, than many or 
perhaps all of the items of knowledge otherwise obtained. 
Indeed, accurately thus to use the revelations of the pa- 
tient's physiognomy is a capability so obviously valuable, 
that it is difficult of comprehension that heretofore little 
or no attempt to extend and systematize this has not been 
considered one of the most legitimate of all undertakings 
conceivable in the psycho-physical. 

When the fields of neurology and of abnormal psy- 
chology are entered, not only do we find ourselves "natur- 
ally" making use of this particular means of gathering in- 
formation, but often we would undoubtedly esteem it a 
valuable accession to our other means of investigation, 
could we probe still deeper with our penetrative glance, be 
much surer of our interpretation, and come to know much 
more accurately how to co-ordinate the entire results thus 
to be obtained, with what we in other ways learn of the 
history, and character, and diseases of the patient in hand. 
In respect of this, the ability, for instance, to see the dif- 
ference between the facial expression of neurasthenia or 
psychasthenia on the one hand, and of the early stages of 
Parkinson's Disease, on the other, may be taken as typical 
of much that in every direction might be of incalculable 
benefit, if methods of investigation and interpretation 
were only comprehensive and refined enough for the pur- 
pose. 

Now, if so much is of use where as yet nearly all is 
purely automatic and instinctive, what might be the ad- 
ditional uses to which properly directed methods of suc- 
cessfully inducing physiognomical responses at will would 
lead, if only we knew how best to do this, and likewise, how 
best to interpretate whatever might thus be intentionally 
educed. That is, why should it not be a most laudable 
undertaking to attempt, at any rate, to devise methods 
by which what is now held to be valuable in our unconscious 
readings of the human face, may be extended, hopefully, at 
least, until every case can be read, not only "as a book," 
but by far more rightly read, so far as diagnostic, prog- 



Smith Baker, M. D. 49 

nostic, and curative knowledge is concerned, than has ever 
been possible heretofore? 

It is, then, not to the everyday automatic readings of 
physiognomies that I would give the term "Physiognomical 
Reflex," but to the additional changes in expression, which 
are to be purposely induced, by measures purposely designed, 
in order to bring out the definitely needed revelation of con- 
trasts and variabilities of ideational content and emotional 
tone and volitional power, which will help to characterize and 
differentiate individual cases, one from the other. This, 
the true "physiognomical reflex" is such, then, only as 
such purposely induced response is secured, and subse- 
quently considered to be, if of the same order as the unin- 
duced automatic facial changes, yet distinctively something 
additional, in that it brings about at the will of the investi- 
gator, and by methods that have been thought out before- 
hand and applied as eflfiiciently as the nature of the case 
admits, certain revelations which otherwise would have 
remained hidden, or at least not fully discovered. Of course, 
this does not imply that the same methods of investigation 
or interpretation are applicable or most useful in all cases. 
Skill in selecting the methods best adapted to secure needed 
results in the case in hand is here as necessary as elsewhere. 
Only, in all cases the principle of the method will remain es- 
sentially the same; namely, that the investigator, by using his 
preconceived notions as to what will work best, proceeds to 
induce such changes in the physiognomical expression of his 
patient as will reveal to him whatever he wishes to learn, to 
every extent possible. As the knee-jerk is induced by the 
proper mechanical blow, so the physiognomical reflex is 
thus to be induced by the proper psychical impact of the 
investigator's exciting sensory or ideational influence. 

It should be noted, in passing, that in this description of 
the physiognomical reflex something more is intended than 
would be included under the simpler term, " facial reflex." 
The term "facial reflex" should be definitely restricted to 
the ordinary reflexes of the facial nerve and its co-ordinates, 
so far as these may be elicited; and, like the ordinary neuro- 
muscular responses to mechanical impact elsewhere, those 
of the facial nerve thus restricted are already incorporated 



50 Preliminary Note on the Physiognomical Reflex 

in neurological nomenclature. Yet, as all have known, at 
least more definitely from the time of Bell, that all sorts of 
influences including mental and emotional states change 
the facial expression through the motor activity of this 
nerve, so its activities must enter extensively into any con- 
sideration of the physiognomical reflex whatever. But 
evidently this latter must include not only the activity of 
the seventh nerve, but also that of every nerve that has in 
the least to do with the head and its carriage, as well as with 
the face and its successive changes in expression. Conse- 
quently, the physiognomical reflex is thus made to be one 
of the most comprehensive in the whole human system. 

Interest in this reflex began and has grown with me, in 
noting the changes in expression which occurred while I was 
putting questions to my patients. The special ways in 
which the physiognomical response was made to these, not 
only by different patients, but by the same patient on differ- 
ent days, or at different hours of the same day, or under 
varying conditions of distraction, fatigue, well or ill-being, 
moodiness, previous engagement, differing expectations, being 
accompanied or alone, and all the rest, became increasingly of 
interest, and in time this interest began to organize itself 
into queries as to further possibilities, and, likewise, into 
desultory efforts to make something further of it. I began 
to see also much more definitely than before, that even with 
but undeveloped skill one could thus learn quite a little 
that was more or less valuable, and which should not be 
neglected. Hence, in time, almost necessarily there arose 
the further query, Why not try to work this field more 
extensively by devising adaptive measures and as opportunity 
offered by using them much more systematically and to 
the point.'* 

Legitimate as this seemed, it was not, however, until a 
much later day that anything like the altogether possible 
uses of the physiognomical reflex in confirming, or negating, 
or modifying the results of other methods of investigation, 
has become apparent. This has come about, more re- 
cently, as I have watched the physiognomies of those under 
various associative tests in psychoanalysis. Here I soon be- 
came convinced that often what I saw in people's faces was 



Smith Baker, M.D. 51 

of equal or more consequence than what I heard by way of 
response to the test-words, or the length of time in which 
the responses varied. Indeed, here seemed to be not only 
sufficient ground for revival of my former but lagging in- 
terest in the physiognomical reflex, but also many a sugges- 
tion of some of the uses to which it could be put, as soon as I 
could devise better measures for its eliciting, and especially, 
for preserving results in permanent records. Before this, the 
data had all been so evanescent and incommunicable, and 
attempts at record and comparison so imperfect and vague, 
that at least half their real value had been irretrievably lost 
in consequence. When also before this I had attempted 
to change the attention of patients, by all sorts of expres- 
sions — startling, mild, jocular, profane, personal, abstract, 
or what not — and had attempted to note the resulting 
changes in expression in consequence, although I had ap- 
parently been on the right track and on one that I might 
continue with increasing profit, yet I could preserve so little 
of my gleanings by the way that useful results had proved 
to be out of all proportion to those expected and needed, 
and doubt as to real values had strongly inhibited further 
investigation. 

More recently, however, in connection with the prac- 
tice of psychoanalysis, interest in the real importance of the 
uses of the physiognomical reflex has been revived to an 
unexpected degree, and has led me to a testing of the whole 
matter with renewed energy and attention. But here again 
interest would undoubtedly have flagged had not I hit 
upon the invaluable camera for making permanent records 
of disclosures which before had been but fleeting and only 
half usable. With the uses of this adjunct fully realized, 
there seems no whit of doubt that the physiognomical reflex 
skilfully elicited and its results permanently recorded will 
prove to be one of the most useful helps to the neurologist 
and psychiatrist, and especially to the borderland psy- 
chologist, that have yet been devised. At any rate, results 
thus far are sufficiently encouraging to provoke still further 
eflforts in developing the method, until at least its practical 
uses shall be proven, or otherwise. 



52 Preliminary Note on the Physiognomical Refl, 



ex 



So far as yet settled upon the best method of procedure 
in the use of the physiognomical reflex is this: 

1. Let the patient first tell his story and as it comes 
to. his mind spontaneously. 

2. Let him repose comfortably, and then by quiet 
suggestion and questioning lead him to amend his former 
statements as he readily can. Record first and second as 
usual. 

3. Let him arise and sit where his face can be noted, 
and where the light is regulable as nearly to a common 
intensity as possible. 

4. Proceed with the association tests in psychoanalysis 
as commonly, watch closely the changes in expression, and 
record these as well as possible by writing in connection 
with each test-word used. 

5. Select from the list of test- words three to five of 
those which were evidently the most disturbing: or any 
other words which seemingly will answer the purpose, per- 
haps better. At intervals of three or four minutes, pro- 
nounce distinctly, but not ostentatiously, one of the select 
words, and, after counting five or so, photograph the ex- 
pression. (The camera should occupy a permanent position, 
and be all ready to use without preliminary focusing or other 
preparation. The negative should not be retouched.) 

6. Repeat the whole proceeding at such intervals as 
may seem necessary to the clarity and validity of results. 

Of course, all this is crude as yet in my own hands; but 
preliminarily it has been worth while, and quite likely others 
may devise methods much better and altogether more 
serviceable. However, the idea of the physiognomical 
reflex, its purposeful eliciting, and its practical interpre- 
tation must probably remain as here stated. As thus de- 
scribed and thus far used, it is evident that the physiog- 
nomical reflex is one that is elicited, not by mechanical 
impacts, but by sensational, ideational, or emotional im- 
pacts, i.e., it is as truly a psycho-motor reflex, as the ordi- 
nary tendon reflexes are physico-motor. But none the less, 
it may well be considered, seemingly, as a true reflex, and 
not one that should occupy a very low rank, either. 
37 Winston Building. 



ABSTRACTS 

Problems of Suggestion {Les Prohlemes de la Suggestion), 
Pierre Janet. Journ. /. Psychol, u. Neur. Band XVII, S. 323- 
342. {Ergdnzungsheft.) 

Nowhere, perhaps, is language so loose as in works on psycho- 
therapy. This lack of precision is especially illustrated in the use 
of the word "suggestion." There are two current usages; the one, 
extensive, tends to give to the word the widest possible inter- 
pretation, while the other restricts its meaning within narrower 
limits. According to the first usage, which we owe originally to 
Bernheim, every psychic impression, in whatsoever manner it 
is received, from whatsoever source, is suggestion. So that in this 
sense suggestion is ultimately synonymous with "thought," 
"psychological phenomenon," "consciousness." 

But it must be recalled that when the early magnetists be- 
ginning with Puysegur first described the reactions which they 
evoked in their subjects, and when Bernheim himself described 
these phenomena, they regarded them as novel and strange. 
There was something about them bizarre and mysterious. So that 
at first they had to contend strongly for the reality of their dis- 
covery. It is precisely this mechanical, involuntary, deter- 
ministic character of the reactions that occasioned the astonish- 
ment of the first observers which in the opinion of Janet warrants 
reserving the word suggestion in its original sense and using it to 
indicate "a peculiar reaction of the human mind to certain per- 
ceptions: this reaction consisting in the complete development 
of the tendency evoked, without which this development would 
be determined through the collaboration of the rest of the per- 
sonality." 

It is necessary to determine with precision in all cases the 
Hmits of suggestion. For example: "It is evidently the actualiza- 
tion of a tendency, the transition from the latent state to one 
representing a higher degree of psychological tension which deter- 
mines actions. But these actions themselves may have all sorts 
of degrees of tension and of actualization. . . . The difliculty 
has been felt with regard to so-called criminal suggestions." 
Janet believes that, while experiments upon the amenability of 
subjects to criminal suggestions performed under artificial con- 
ditions are inconclusive because of the subject's sense of their 
unreaHty, it is unfair to conclude that veritable criminal acts 
might not also be produced through the mechanism of suggestion. 
"It is enough," he says, "to observe the genuine acts of patients 

53 



54 The Journal of Abnormal Psychology • 

to be convinced of this, and facts of this kind have often been 
described." Janet feels that three cases collected by him are 
sufficiently clear to bear him out in his view, cases "in which sug- 
gestions by word addressed voluntarily to particular individuals 
in a special mental state determined actual crimes." 

This problem of the different degrees of psychological ten- 
sion and of reality is not limited to the question of criminal acts, 
it is pertinent to all suggestions. Because an individual lets his 
arm fall limp at his side, when it is suggested to him that it is 
paralyzed, one may by no means conclude that experimental 
suggestions could rapidly produce paralysis upon a great number 
of persons and under all circumstances. As in the case of spurious 
criminal suggestions, "the subject knows very well it is only play. 
. . . It is again a low degree of actualization." 

"What characterizes the true paralysis is that it persists 
in spite of the need the subject has for his arm. . . " It is its 
persistence for a long period and under all circumstances which 
proves its reality, but this test of permanence has not been ap- 
plied in the case of suggested paralysis. 

The question of the duration of suggestions also deserves 
careful study. Another point of importance is the degree of 
credence accompanying the actualization of suggestions in the 
different categories of patients. And finally it is important that 
we study the degrees of organic modifications really determined 
by true suggestions. 

Janet finally passes in review the three leading theories of 
suggestion. Of the theory that suggestion is a phenomenon of 
attention, the conception of Braid, of Hack-Tuke, and of Liebault 
lately developed by Munsterberg in his "Psychotherapy," Janet 
makes short work. Suggestion is more effective precisely under 
conditions of mental abstraction. What is more the suggesti- 
bility of patients is observed to disappear when their power of 
attention is developed. 

In discussing the theory which explains suggestion as a phe- 
nomenon of docility, Janet gives implicit evidence of a surprising 
lack of familiarity with the principles of genetic psychology de- 
veloped by Freud. For it is undeniable that Freud's psycho- 
analytic researches furnish the strongest material in support of 
the theory which explains suggestion on the ground of certain 
unconscious social relationships having their root in the experi- 
ences of early childhood. It is characteristic that Janet prefers 
the theory of Richet, according to whom suggestion is a phe- 
nomenon of monoideic automatism, for Richet's is the descriptive 
theory par excellence, and here, of course, Janet is most at home. 



Abstracts 55 

It Is the incomparable power of description and co-ordination 
which he brings to the intricate problems of abnormal psychology 
which is Janet's especial forte. The more philosophical task of 
analysis requisite to a dynamic appreciation of individual psy- 
chology is of course wholly alien to Janet's particular metier. 

Janet's paper, like Bernheim's, is a discussion of words, which 
a very little elementary analysis would go far to show the futility 
of and speed us on to more profitable concern. Janet prefers 
to use the word suggestion in the more specific sense defined by 
him. Bernheim likes better to give it the significance of a general 
term synonymous with mental impression. Argument is to no 
avail. The matter is not question for an umpire. Each of us 
will have to make his private selection between the two in accord- 
ance with his own subjective predilections. The reviewer leans 
to Janet's usage, chiefly because as a pupil of Jung's it seems to 
him to accord with conceptions based upon the principles of psy- 
choanalysis. 

On the same ground it is difficult to participate in the view 
that suggestion is a pathological phenomenon. But let us not 
raise the question of what we mean by "pathological'*! 

Trigant Burrow 



The Value and the Significance of the Psychoanalytic 
Method for the Diagnosis and Treatment of the Neuroses. 

{Ueber den Wert und die Bedeutung der psychoanalytischen Methode 
fur die Diagnose und Therapie der Neurosen.) Seif. Journ. f. 
Psychol, u. Neur. Band XVII, S. 401-411. (Ergdnzungsheft.) 

Seif's paper condenses admirably theclinicalbearingof Freud's 
psychological conceptions. It is a direct, practical statement 
of the dynamic viewpoint in psychopathology, and is presented 
without the least trace of subtlety or extravagance. But even so, 
one looks upon the undertaking with misgivings; for it is a thank- 
less one, this of attempting to win over to Freud's platform even 
the most enlightened and tolerant of audiences by mere precept 
and example. To those who have spared the time to devote a 
considerable period to a quite earnest and exclusive study of Freud's 
psychology of the unconscious, the inherent difficulties of Seif's task 
are patent. Indeed "difficulties" is but a lame word. Rather is it 
a task that is of its very essence foredoomed to failure. By the con- 
ditions of the premises it must be so. "Else," as Seif says, "it 
were, after all, a false theory of Freud's that resistances against sex- 
uality exist in the healthy ... as well as in the neurotic." Of course, 



56 The Journal of Abnormal Psychology 

then, he tells his audience, he cannot expect that his words will 
carry conviction. Were it so, the whole Freudian structure would 
collapse. For the whole matter in question, Seif substantially 
says, is precisely the universal repression of the entire affective 
sphere residing under the dominion of sexuality. Is it any wonder, 
then, that my hearers who enjoy no peculiar exemption from this 
all-pervading social complex should betray their resistances by 
peremptorily rejecting, without more ado, the thesis here de- 
fended ? 

Here is an argumentum ad hominem with a vengeance! And 
one may imagine with what choler Freud's opponents listened to 
these searching incriminations. But as if this were not enough, 
the author adds the unmitigated affront of suggesting to his audi- 
ence that the way of atonement lies in an analysis of themselves! 

At a distance of safety one's fancy is stimulated by the dra- 
matic interest of the ensuing scene. Fancy the sour raspings with 
which this odious unction is rebuffed! But gall and wormwood 
though it be, it is none the less true that self-analysis is the in- 
dispensable ceremonial of initiation into the psychoanalytic mys- 
teries and it is precisely this preliminary ordeal to impalement 
that makes of us all such refractory goats! 

Seif is perfectly frank. He by no means presumes to take 
the high ground of a cabalistic wiseacre and assume a snobbish 
superiority. Not in the least. On the contrary, he owns quite 
honestly that he was for many years in precisely the same case with 
the dissenters, that he was at first equally averse to a system of 
psychology which made of the vita sexualis its solar center. All 
this he readily admits. But insists, on the other hand, that in- 
creasing familiarity with the psychoanalytic method has con- 
vinced him more and more of the inherent validity of its central 
issues. 

The author is wise enough, too, to admit that future investi- 
gation may find it necessary to run the blue pencil through certain 
passages of Freud's present-day dicta. From all which it is seen 
that Seif's attitude is an entirely dispassionate one. Like Jung, 
his plea is merely for the recognition of the working hypothesis 
which Freud has given us, and for the acceptance of whatever 
of Freud's deductions may be regarded as shown empirically to 
be well based. 

Self brings to psychoanalysis a sane scientific conservatism. 
He Is of those who have taken the precaution to keep on safe 
ground. 

Trigant Burrow 



Abstracts 57 

THE CLINICAL DIFFERENTIATION OF NEURASTHENIA AND THE 

PSYCHONEUROSES, INCLUDING HYSTERIA. Bemheim. Jour. j. 
Psychol, u. Neur. Band XVII, S. 317-319. (Ergdnzungsheft.) 

At the conclusion of his paper Bernheim tersely sums up the 
substance of it. "To resume," he says, "psychotherapy cures 
the psychoneuroses, but it does not cure organic diseases; it may 
sometimes cure toxic disorders developed from anxiety states, by 
correcting the latter; but it does not cure a true neurasthenia 
nor a psycho-neurasthenia, conditions having always an auto- 
toxic origin." 

In thus differentiating neurasthenia from the psychoneuroses 
Bernheim is in full accord with Freud. Both are here returning 
to etymological ground. They demand that "neurasthenia" 
mean what it purports to mean; that it stand literally for the con- 
dition it describes, namely, a depleted state of the nervous system, 
a fatigued condition of the neural elements, a modification repre- 
senting a morbid physiological process. So that in contradis- 
tinction to the psychoneuroses which are due to psychogenic 
factors neurasthenia is for Bernheim as for Freud, a disorder due 
to psychogenic factors. 

Thus far Bernheim and Freud go hand in hand. Their ways 
divide when they come to the practical business of sorting the 
manifold disease-entities occurring within the nebulous realm of 
"nervous manifestations." Freud is exceedingly chary of ad- 
missions into his group of etymological neurasthenias. Bernheim 
is more liberal. Like the vastly greater number of psychopa- 
thologists he regards a high percentage of nervous patients as 
eligible to the class of physiogenic disorders commonly sub- 
sumed under the term "neurasthenia," and, like them, enrolls 
a large number. 

The explanation of the disparity in the views of the two in- 
vestigators is clear. Freud has discovered and employed a method 
whereby certain morbid conditions of a presumably physiologic 
origin are proven to be psychogenic in character — his psy- 
choanalytic method. Having such a method at his disposal 
Freud very naturally is enabled to differentiate a greater number 
of such psychogenic disorders than one not in possession of this 
diagnostic means. Precisely as the bacteriological expert is in a 
position to demonstrate a greater number of diseases of bacterial 
origin than one not adept in the usage of bacteriologic technique. 

One is surprised at Bernheim's rather premature statement 
that the true neurasthenias, psychasthenias, and psycho-neuras- 
thenias are invariably of an auto-toxic origin. This view is as yet 
wholly unbased. As Forel said in the discussion, "It is pure 



58 The Journal of Abnormal Psychology 

hypothesis." "Until the microbe or toxine has been discovered 
. . . such assertions are wholly in the air." 

In Bernheim's statement that "all so-called hypnotic phe- 
nomena are only suggested psychoneuroses," one detects a distinct 
Freudian ring. One thinks of Ferenczi's brilliant essay, "Intro- 
jection und Uebertragung," in which he so masterfully shows 
the subjective agreement between the psychic state induced by 
hypnosis and that obtaining in the unconscious fancies preserved 
in the latent memories of early childhood. 

What especially excites the reviewer's criticism toward 
Professor Bernheim's paper, as well as toward the discussion follow- 
ing it, is the glaring illustration here offered of the inveterate 
tendency of the medical mind to paraphrase symptom-complexes 
with Greek names, and then, apparently forgetting that such 
designations are employed merely as symbols of subjective im- 
pressions, to reverse its course completely and spend hours in 
futilely arguing their "meaning." As if such conceptual con- 
notations could ever mean anything but what, in the privacy of 
the speaker's own consciousness, he intends they should mean by 
reason of his interpretation of the data symbolized by them ! 

But to take up the cudgels against this ancient fallacy is to 
overstep the bounds of the reviewer. 

Trigant Burrow 



AN EXPERIMENTAL CONTRIBUTION TO THE PSYCHOPATHOLOGY 
OF i:)ISTURBANCES IN THE INTERNAL ATTENTION-POWER. {Experi- 

menteller Beitrag zur Psychopathologie der Merkfdhigkeitsstorungen.) 
Joseph Julius Prager, Jour. /. Psychol, u Neurol., Bd. xviii, 
Ht.lu.2, Feb., 1911, S. 1-22. 

After a brief sketch of some of the work previously done in 
this direction (namely by Schneider, 1901, Krauss, Finzi, Brod- 
mann, Boldt, Gregor, Goldstein, 1906), Prager sets forth the 
method used by Pappenheim for the diagnosis of this peculiar 
form of derangement in the intellectual processes. By the psy- 
choanalytic method Jung has shown defects in the accuracy of 
the reproduction of associations, and Pappenheim devised the 
plan of having the patients immediately repeat the association, the 
proportion of changes apparently indicating the degree of "loosen- 
ing" in the basal associative processes of the brain. This per- 
centage varied between fifteen and eighty-five, the maximum re- 
lating to elderly persons ill with functional or organic brain disease. 

Prager's research, extending Pappenheim's work, was made 



Abstracts 



59 



upon five patients — three women and two men — whose ages were 
respectively sixty-four, fifty-six, seventy-four, fifty-four, and 
seventy-six years. Each subject in the association-reaction ex- 
periments gave from one hundred to one hundred and fifty double 
reactions, Jung's scheme of test-words being employed. 

The work set out to answer two questions particularly: 1, 
Is there in psychoses characterized by disturbances in the internal 
attention (Merkfahigkeit) a defect in the association-process? 
and 2, Can we demonstrate by association-experiments (in par- 
ticular by Pappenheim's presented method of immediate repeti- 
tion) phenomena characteristic of these disturbances.'* The five 
patients seem to provide material for answers to these questions. 
For example, their respective mean reaction-times for association 
were long: 4.9, 3.2, 4.0, 10.9, and 5.0 seconds. The percentages of 
different associations in immediate repetition were respectively 
86; 33; 70, 62, 60, 42 (four series of experiments); not stated; and 
8. The other individual differences in these five patients, in re- 
lation to their association records especially, make interesting 
reading but are too long to be reported here. 

In general, it appears that in the two tests (the first association 
and immediately its repetition) reactions of like meaning nearly 
always occurred in shorter time than those that were of different 
sense. This is shown in the following table derived from the five 
patients: 





Similar 
reaction 


Second short 
reaction 


Second fihort reaction 


Similar reactions 




In like 
reactions 


In unlike 
reaction 


Shorter time 


Ayerage time 


Longer time 


Frau K. 


14 


18 


12 


6 


1 


1 




Frau B. 


50 


28 


23 


5 


10 


17 




Frau H. 


34 


17 


14 


3 


13 


6 


1 


Herr F. 


33 


17 


14 


3 


9 


5 


6 


Herr H. 


26 


12 


11 


1 


10 


5 





In reply to the two questions proposed for answer by the 
experimental work, Prager concludes: "With every disturbance 
of the noticing-faculties (Merkstorung) there is necessarily con- 
nected a derangement of the association-process, both being 
apparently symptoms of disintegration underlying association. 
Association-experiments, according to Pappenheim's method of 
immediate repetition, allow us to plainly recognize both of these 
conditions by the large proportion of different associations ob- 
tained as well as by the relatively shorter reaction-times in the 
similar associations." 

Besides these two main results there are several things of 
minor psychologic and physiologic interest in this report of 



60 The Journal of Abnormal Psychology 

Prager's work, but their discussion comes hardly within the limits 
of this review. The original paper merits the careful perusal of 
those especially interested in these very obscure and recondite 
processes of the cognitive phases of the mind and brain. 

Methods similar to this seem to be teaching us more just now 
than the no less scientific but slower delving into neural chemistry 
and physics. 

George V. N. Dearborn. 



THE PSYCHOPATHOLOGY OF EVERYDAY LIFE. EmCSt JoueS. 

American Journal of Psychology. October, 1911. Vol. XXII. 
P. 477. 

This paper contains a detailed exposition of the topics dealt 
with by Freud in the book of the same title. The principal thesis 
of this is that certain inadequacies of our mental functioning, and 
certain apparently purposeless performances, can be shown by 
means of psycho-analysis to have been determined by motives of 
which we were not at the time aware. The occurrences in question 
have the following characteristics in common: They belong to 
what may be called normal behaviour. They are only temporary 
disturbances of a function which at another moment would be 
correctly performed. Their incorrectness is at once recognized 
as soon as attention is drawn to them. 

• The defects in question may be divided into motor and sen- 
sory (in the neuro-biological sense of the terms). Those of the 
former class that enter into consideration are two: (1) The 
erroneous carrying out of an intended purpose. This includes 
such things as slips of the tongue, slips of the pen, and the er- 
roneous carrying out of more complicated actions. (2) The 
carrying out of an unintended purpose, actions that are done auto- 
matically and are hardly noticed by the person. The defects 
of the second class are also two: (1) Simple failure of perception. 
This includes numerous acts of forgetting matters or names that 
one knows quite well, omitting to do something one intended to» 
etc., and also more directly sense symptoms, such as overlooking 
something or somebody that at another moment one would cer- 
tainly notice. (2) Erroneous perception. Instances of this are 
false recollection, i.e., errors in memory, and false visual percep- 
tion, i.e., mistakes in seeing. In each class the distinction between 
the two kinds of defect is not sharp; in the latter one, for instance, 
a failure to remember is always accompanied by an over-prominent 



Abstracts 61 

remembrance of some associated memory, a false recollection which 
may or may not be recognized to be such. Further, the distinction 
between the two classes themselves is not a sharp one, both motor 
and sensory processes playing a part in many instances; thus, in the 
mislaying of objects, the object is first misplaced, and then the 
memory of the act is forgotten. 

Common to all forms is the fact that the subject, and most 
observers, either give an obviously inadequate explanation of the 
particular occurrence, such as that it was due to "inattention," 
"absent-mindedness," "chance," and so on, or frankly maintain 
that it has no mental explanation at all. On the contrary, psycho- 
analysis shows not only that there is a definite psychical cause for 
the occurrence, but that this has always a logical meaning, and 
may strictly be called a motive. This motive is some secondary 
tendency or train of thought, of which the subject is not aware 
at the time. Usually it is fore-conscious, but in many cases it is 
unconscious, and then is correspondingly more difficult to reveal; 
in most cases there are both a fore-conscious and unconscious 
motive, which are associated with each other. The motive is 
repressed by the subject, either at the moment or permanently, the 
repression being a defence-mechanism that subserves the function 
of keeping from consciousness undesirable, disturbing, or painful 
thoughts. The motive may be one of two kinds: either it is a 
counter-impulse directed immediately against the mental operation 
that is intended, or it is an impulse directed against some mental 
tendency that stands in some associative connection with this 
operation; that is to say, the association between the two mental 
processes may be either intrinsic or extrinsic. As a result of the 
repression any direct manifestation of the tendency is inhibited, 
and it can come to expression only as a parasitic process engrafted 
on another, conscious one. The disturbance thus caused consti- 
tutes a temporary failure or error of normal mental functioning. 

This error can psychologically be compared with a psycho- 
neurotic symptom, the mechanisms by which the two are brought 
about are almost the same, and the psychical material that is the 
source of them is closely similar in the two cases. It is maintained 
that appreciation of the significance of these everyday errors is 
important for both the practice and theory of psychology; this is 
especially so in the contribution it furnishes to the problem of 
psychical determinism, and in the understanding it gives of the 
deeper, non-conscious motives of conduct. It further throws a 
valuable light on certain social problems, notably the question of 
mutual misunderstandings in everyday life, and on the importance 



62 The Journal of Abnormal Psychology 

of affective influences in forming decisions and judgments. The 
paper is accompanied throughout by a number of illustrative 
examples. 

Author's Abstract. 

the relationship between dreams and psychoneurotic 
SYMPTOMS. Ernest Jones. American Journal of Insanity. 
July, 1911. Vol. LXVIII. P. 57. 

The clinical and psychological relations between dreams and 
psychoneurotic symptoms are much closer than is generally sus- 
pected. They are here classified into the following four groups: 

General Characteristics. Both dreams and neurotic symptoms 
frequently present the appearance of bizarreness and incompre- 
hensibility, which, however, is due to the fact that they are the 
disguised and distorted products of underlying thoughts that have 
a perfectly logical meaning. Both have a remarkable tendency 
to become either forgotten or else falsified in the later memory. 
They are intimately connected with the subject of superstition. 

Clinical Relations. Neurotic symptoms may actually date 
from a given dream, though in this case they both have a common 
cause in some buried thoughts. Certain symptoms even in their 
external appearance strikingly resemble dreams, and in fact are 
known as dream-states. Neurotic symptoms, such as fears, may 
occur in dreams, and then the analysis of the latter affords an 
easy access to the meaning of the former. 

Psychological Structure. Both dreams and neurotic symptoms 
are compromise-formations, and result from the conflict produced 
by the interaction of two opposing sets of forces. The individual 
mechanisms by means of which the structure is built up are 
identical in the two cases; such are the condensation, displace- 
ment, neologism-formation, reversal, and so on. 

Latent Content. The material obtained by superficial study 
of the sources of dreams and neurotic symptoms appears to be 
quite heterogeneous, and the conclusion may hastily be reached 
that the latent content, or underlying thoughts, has no charac- 
teristic features. On the contrary, the true latent content, which 
lies deeper than this material, is found to be specific and homo- 
geneous, and to present the following constant features in both 
cases. (1} The latent content is always unconscious, that is, it 
consists of mental processes of which the subject cannot become 
aware by direct introspection, but only by means of certain in- 
direct modes of approach. (2) These mental processes are never 
indifferent to the subject, but are highly significant, and have 



Abstracts 63 

been repressed into the unconscious on account of their being un- 
acceptable to the conscious mind. (3) The latent content is of 
infantile origin, later additions being merely reinforcements of 
earlier infantile trends. (4) It is always of a sexual nature. 
(5) It consists of an imaginary gratification of one or more re- 
pressed wishes. 

Of great practical importance is the fact that in many cases 
the latent content of both dreams and neurotic symptoms is identi- 
cal; that is to say, the mental causes of a neurosis will sooner or 
later also come to expression in the patient's dreams. This is 
equally significant for pathology and therapeutics. A knowledge 
of the nature, mechanisms, and meaning of dreams is indispensable 
for the understanding of the psychoneuroses, and also of the psy- 
choses. Nothing better demonstrates the unity of the laws apply- 
ing to both normal and morbid processes than does the study of 
dream life. This study is of value to therapeutics in two ways. 
First it provides the readiest and most direct route to the patients 
unconscious, where the conflicts are taking place that form the 
basis of the surface symptoms, and this deeper knowledge and 
comprehension of the sources of the disorder of itself puts one in 
a better position to deal with them. Secondly, the mere carrying 
out of the dream analyses is a therapeutic measure of very great 
value, for it cannot be done without to some extent overcoming 
the resistances that are maintaining the neurosis. Dream analysis 
is the most Important part of the psycho-analytic method of 
treatment. 

The differences between dreams and neurotic symptoms are 
next discussed, and it is pointed out that these are less fundamental 
than might at first sight appear. Dreams are the neurosis of the 
healthy, just as a neurosis is the dream of the Invalid. Fourteen 
examples of dream-analysis are related so as to illustrate each of 
the above-mentioned points. 

Author's Abstract. 



THE PSYCHOLOGICAL METHODS OF INVESTIGATION. {Die pSJ- 

chologische Untersuchungsmethoden.) Sommer. Klinik filr psychische 
und nervose Krankheiten. 1911. Band VI. Heft 3. S. 205. 

In this paper, which formed part of a symposium at the 1911 
meeting of the German Psychiatrical Society, Sommer gives a 
valuable review of the present-day methods of psychological 
Investigation, particularly those applicable to psychiatry. He 
confines himself largely to those methods that have been dis- 



64 The Journal of Abnormal Psychology 

covered or extended within the past eleven years. These he 
groups as follows: 

1. Representation of Optical Phenomena. 

This includes improvement in photographic technique, cine- 
matography, and stereoscopic methods. 

2. Expression of Movements. 

A. Dynamometry. Sommer discusses and criticizes Weiler's 
principle of dynamometry, and the modifications of Mosso's 
ergograph. 

B. Experimental Physiognomy. Methods for registering 
synergic phenomena in regard to (a) the frontal muscles, (b) the 
ocular muscles, (c) the movements of laughter. 

C. Speech Processes, (a) Rousselot's method for repre- 
senting the movements of the vocal cords; (b) Garten's soap- 
bubble process for registering whispering movements; (c) Phono- 
graphic studies of speech. 

D. Body Posture. Varieties of the three-dimensional meth- 
ods, which have also been applied to the study of hand- 
writing. 

E. Vasomotor Methods. Sphygmographic errors can be ex- 
cluded by registering the pulse beats as a series of sounds (pul- 
sophone). Errors have been found in plethysmographic work 
through the importance of complications due to muscular action 
having been determined. Marbe's flame method of noting changes 
of pressure is referred to. 

F. Secretory Methods. Sommer hopes much from an 
extension of Pawlow's line of experimental work to clinical prob- 
lems, such as the gastric disturbances of different forms of neu- 
rosis, etc. 

G. Cutaneous Electrical Methods. A number of problems 
are discussed in connection with the psycho-galvanic phenomenon. 

3. Reflexes. 

A. Knee Jerk. A number of special apparatuses have been 
devised in the past few years for the more exact study of this typi- 
cal reflex, the work of Weiler and Pfahl being the most valuable 
and extensive. 

B. Pupillary Reflex. Weiler's and Bumke's work is shortly 
mentioned. 

C. Investigation of Simple Psychical Reflexes. Under this 
heading Sommer includes (a) optic motor processes, (b) acoustic 
motor processes, (c) tactile motor reactions, (d) reactions to heat 
and cold stimuli, (e) olfactory stimuli. 

4. Laboratory Arrangements. 



Abstracts 65 

A number of technical improvements in laboratory fittings 
are pointed out. 

5. Pure Psychological Methods. 

A. Investigation of Speech Processes. This especially 
refers to the work of Wernicke's successors, such as Liepmann, 
on the relation of disturbances of speech (aphasia) to organic 
brain disease. 

B. Investigation of Orientation. The distinction between 
true and apparent confusion, and similar matters. 

C. Investigation of School-knowledge. Two methods are 
mentioned, the first one, which is better suited for psychiatrical 
work, being the use of a small number of selected questions; the 
other, better suited to pure psychological work, being an inventory 
of the whole field of knowledge. 

D. Arithmetical Capacity. It is not the number of mistakes 
made so much as the kind of mistake that is of interest for clinical 
purposes. 

E. Memory. The apparatuses of Ranschburg and Wirth 
are discussed. The chief progress here is due to Stern's work on 
false testimony, especially carried out with children. This di- 
rection of work has a great clinical and legal future. 

F. Intelligence. The recognition of the frequency of pseudo- 
intelligence has complicated this problem. In the study of im- 
becility it has been found that the great variety of intelligence 
defects and the fact that this represents only one component of the 
mental disorder have shown the matter to be far more complex 
than was previously thought. 

G. Associations. Enormous progress has been made in this 
sphere, but the subject is omitted here for want of space. 

H. Complexes of Ideas. The importance of Jung's work 
is more and more recognized, and of the effectivity of complexes 
there is no doubt. 

J. Psycho-analysis. Sommer appears to agree with the 
principles of this, and of the pathogenic importance of sexual com- 
plexes in certain cases, but he disapproves of the tendency to 
generalize this latter finding. 

K. Character Moods. Much useful work has been done 
in this sphere. 

6. Individual Psychology. 

In a single paragraph Sommer calls attention to the importance 
of this subject for psychiatry, and lays stress on the study of 
character anomalies previous to the outbreak of mental disorders. 

7. Psychology of Descendance. 



66 The Journal of Abnormal Psychology 

In this field Sommer himself has been a pioneer. He calls 
attention to the various fallacies that have to be avoided in such 
work, and the methods whereby it can be pursued. 

8. Criticism of the Mystical Direction in Psychology. 

Sommer urges that science should no longer ignore, but should 
critically examine such matters as clairvoyance, thought-reading, 
telepathy, and other spiritistic beliefs. He indicates some of the 
fallacies to be avoided, and welcomes the work done in recent years 
on the subject of superstition, magic, evil eye, thought-transfer- 
ence, etc. 

9. Animal-Psychology Methods. 

A short indication is given of the work carried out on this sub- 
ject. 

Ernest Jones. 

a contribution to the casuistics of "pseudologia phan- 
TASTiCA." {Ein Beitrag zur Kasuistik der ^^ Pseudologia phantas- 
tica'') Erich Wendt. Allg. Zeitschr. f. Psychiatrie. 1911. 
Band LXVIII. Viertes Heft. S. 482. 

Delbruck introduced the term Pseudologia phantastica to 
denote a tendency to pathological lying, where the mixture of 
direct lying and error is so close that the patient is no longer able 
to distinguish reality from the creations of his fancy. The con- 
dition may be found in various disorders, such as imbecility, 
paranoia, and so on, but the purest and most classical types of it 
are usually met with in hysteria. 

The fundamental cause of the tendency is not so much the 
impulse to relate such and such a thing, or to strive towards it, 
as the irresistible desire to be, to live, to think, to feel, like some 
other being who is the ideal of the patient's phantasy, in other words, 
to pose before himself and the world as some one different from his 
real self. Ziehen explains the symptom as a heightened activity 
of the phantasy produced under the influence of personal vanity, 
but Wendt remarks that, since this vanity is after all nothing 
but the wish to appear as highly favored in some respect or other, 
and since it is the emphasizing of this wish factor that ends in a 
complete auto-suggestion, one gets deeper into the essence of the 
conception in accepting Stemmermann's and Vogt's idea of a 
Wish-psychosis. In this way under the term pseudologia phan- 
tastica is to be conceived not merely the naked picture of path- 
ological lying, but the subjugation of the consciousness of reality 
by the morbid Wish of the phantasy. The true memory of real 
experiences appears in the phantasy, but only as an island, as in 



Abstracts 67 

a misty dream. This may even result in a double consciousness 
where the real and the wish form of life course side by side, or 
alternately, the second form being the dominant one. Wendt 
then discusses the practical relations of the condition to criminality 
and to medico-legal questions. 

A case is then narrated at length. The patient was a student 
of law, aged twenty-two. The morbid condition, although resting 
on constitutional grounds, appeared periodically on three oc- 
casions the first of which was at the time of puberty. On the last 
of these the condition was much exaggerated, the patient posed 
as a count, conducted himself accordingly and ultimately came into 
conflict with the law over money matters. He imagined himself 
possessing all sorts of enviable attributes, and quite confounded 
reality and fiction. Wendt discusses the clinical diagnosis, es- 
pecially between paranoia, mania, and hysteria, and considers 
the case to be more nearly allied to the last named. He finally 
deals with the legal and prognostic aspects of the case. 

Ernest Jones. 



DE l'attention. E. Riguano. Scientia. Vol. X, No. 20, 1911. 

This paper constitutes the first part of the author's contribu- 
tion to the subject of attention. Attention is one of the most im- 
portant of mental phenomena and consists of certain reactions to 
distance receptors by which the organism is maintained in a longer 
or shorter state of suspense. Phylogenetically, many of these 
states of suspense or attention arose from memories of past de- 
ceptions to which the organism had been subjected. Frequent 
deceptions gave rise to certain useless, consumatory acts, therefore 
the failure to react in a certain manner produced antagonistic 
acts or a maintenance of the organism in suspense. It is precisely 
this state of suspense which constitutes the state of attention. 
This theory of the evolution of attention is similar to Jenning's 
theory of the birth of intelligence arising from the "method of 
trial and error" in lower organisms and is distinctly opposed to any 
mechanistic hypothesis. 

Attention, therefore, seems to have evolved from reactions to 
distance receptors. It is made up of the contrast between two 
affective tendencies, of which the second, inhibited by the first, 
ceases its complete activity for a time and is thus maintained in 
suspense or attention. According to this theory the primary 
cause of attention seems to be antagonistic affective states, and 
conversely, there can be no state of attention without this affect- 
ive antagonism. Curiosity is one of the light forms of this affect- 



68 The Journal of Abnormal Psychology 

ive contrast and is a special state of attention produced by new 
stimuli or circumstances. If this affective activity or Interest be 
reduced to a minimum, attention becomes blunted. When It is 
reduced to zero, sleep results, because we sleep In the exact meas- 
ure that we are disinterested. He does not agree with RIbot's 
theory that motor phenomena are the prime factois In all atten- 
tive processes, but thinks that attention is pre-eminently of cen- 
tral origin. The motor elements of attention are merely secondary 
manifestations and are not Indispensable for attentive processes. 

Intense attention is concentrated or narrowed on one object 
and thus produces a state of distraction or mental dissociation. 
Light attention passes quickly from one object to another. Thus 
attention safeguards the unity of consciousness, although It is not 
a necessary condition of consciousness. 

I. H. CORIAT. 
PSYCHASTHENIA AND INEBRIETY. Tom A. WUUamS, 

National Association of Study of Alcohol and other Narcotics. 
Atlantic City, June, 1909. 

Dr. Williams begins with the consideration of the psychas- 
thenic constitution, how It Is acquired, Its relation to the need for 
excitation, how to compensate for psychasthenic insufficiencies, 
prevention In childhood and youth. 

1. Constant Interferences with the spontaneous volitions of 
the child induce mental hesitation and doubt and search for 
approval before any act Is begun, producing a premature and indis- 
criminate inhibition. Activities thus frustrated find their expres- 
sion In such derlvlties as grimaces and tics, morbid fears and mental 
ruminations and obsessions. 

2. The chronic dissatisfaction thus engendered, when once 
removed by the forgetfulness of narcosis, again seeks this means of 
terminating itself, and a habit of drug taking is easily formed. 

3. The psychotherapy of the psychasthenic state must afford 
innocuous satisfactions for a desire which Is only unphyslological, 
because of Its insistence and lack of correspondence with environ- 
ment. The most satisfying and permanent of these Is work 
of a definite kind, to call into action and gradually fortify the voli- 
tional power. This is best done by motorlal and especially produc- 
tive activities. In which the sight of something accomplished tends 
to remove the sense of Inadequacy and want of achievement felt 
by psychasthenics. 

4. Prophylaxis In childhood and youth against insufficiencies 
of this kind is best accomplished by games, the interest In which 



Abstracts 69 

causes vivid attention and practice In concentrating the full 
activity upon the task In hand; whence the best guarantee for 
success In performance and the feeling of personal triumph gained 
by one's own efforts and not merely Imparted by the reflected 
glory of one's associates. Games must be supervised to guarantee 
the weaker, who require them most, against the discouragement 
of their activities by those who excel them. 

Author's Abstract. 



REVIEWS 

THE WORLD OF DREAMS. By Hdvelock ElUs. Boston, 1911. 
Houghton, Mifflin & Co., pp. 288. 

In this popular study of the nature and genesis of dreams, 
Havelock Ellis approaches the dream problem by the intro- 
spective method, although, as must be evident in a book intended 
for popular reading, he does not enter into the details of psycho- 
analysis. The dream mechanisms discussed are chiefly those 
of normal dreaming. According to the author a large majority 
of dreams originates in tactile, auditory and even visual periph- 
eral stimuli. This furnishes the main theme of the book. Con- 
cerning the actual mechanism of the dream, however, that is, 
the dream work and the transformation of these peripheral stimuli 
into dreams, he leaves us In the dark. It seems strange that he 
does not devote more space concerning pathological dreams and 
their value as a most convenient method for exploring the un- 
conscious, as such details would Interest the popular mind and 
could be given without entering into the finer technique of psycho- 
analysis. Although he gives a most Interesting account of the 
psychology of dreaming, yet we cannot agree with his contention 
for the peripheral origin of all dreams, as the result of all psycho- 
analysis strongly militates against a theory of this sort. He rightly 
discards any supernatural element In dreams, such as prophecy or 
premonitions of the future. In turn, he discusses motion, avia- 
tion, symbolism, and memory In dreams, and he insists on the 
evolution of myths and folk lore as arising out of the dreams of 
primitive man, a point which has recently been elaborated by the 
followers of Freud. As must be expected in a popular book, one 
misses any profound psychological analyses of dreams. He points 
out, and here we agree with him, that the introspective method of 
dream study is far more valuable than the experimental or sta- 
tistical method. The portion of the book devoted to Freud gives 
an interesting but rather condensed account of his work on dreams, 
and we note with interest that he disagrees with Freud In not 
interpreting all dreams as an imaginary wish fulfillment, a ten- 
dency which must force itself upon any one who has had any prac- 
tical experience with the psychoanalysis of dreams. The wish is 
not the fundamental and positive element In dreams, because the 
unconscious may have other functions beside wishing, such as 
fear, mental conflicts and even non-fulfillments of wishes. 

He divides dreams into the peripheral or presentatlve group, 
excited by a stimulus from without and a central or representative 

70 



Reviews 71 

group, having its elements in conscious or unconscious memories. 
However, he almost completely rejects the latter type and be- 
lieves that all dreams have received their initial stimulus from 
some external or peripheral source or some internal organic stimu- 
lus. We cannot fully agree with this viewpoint, although admit- 
ing at the same time that some dreams may have a purely periph- 
eral origin. This, however, at once plunges us into the im- 
mense difficulty of interpreting how an elementary external 
stimulus can be transformed into an, elaborate or complex dream, 
particularly since, in sleep, there is an almost complete absence of 
external stimuli. 

The dreams of flying (aviation dreams), he interprets as due 
to the diminished state of tactile pressure in sleep, and not, as 
Freud claims, for instance, in his analysis of Leonardo da Vinci, 
to a concealed sexual wish. Sometime the same symptom is 
found in hysteria, that is a sensation of abnormal lightness of the 
body due to the tactile anaesthesia. This is evidently the ex- 
planation of the hysterical ecstasy, which played so great a part 
in the sensations of levitation in the religious manifestations of the 
medieval saints. On the whole, the book is clearly and inter- 
estingly written, is full of interesting material, and furnishes an 
excellent introduction for the lay reader to the scientific study of 
dreams and their mental mechanism. 

I. H. CORIAT. 



SCIENTIFIC MENTAL HEALING. By H. Addingtofi Bruce, 
[M.J.] Boston. Little, Brown and Company, 191 L Pp. ix, 258. 

This readable book is made up of eight chapters, four on the 
history and methods of psychotherapy, one on dissociated per- 
sonality, one on some of the recent practical applications of psy- 
chology, one on psychical research, and the eighth chapter is 
one of the very numerous appreciations of the great William 
James. Just about half of the volume, then, deals with mental 
healing, and to very many people It will serve as a relish for more, 
for it is written In a clear and simple style with variety of fact 
and illustration and the subject already Is a reasonably large one. 

The first chapter, "The Evolution of Mental Healing," 
points out the probable usefulness of hypnosis among the early 
Egyptian, Indian, and Chinese priesthood; deals briefly with 
Mesmer, Braid, Llebeault, and others, and very properly proceeds 
to give to Quimby the credit due him for his Influence on the mental 
healing culture of our own day. The two chapters following, 
"Principles and Methods" and "Masters of the Mind" by name. 



72 The Journal of Abnormal Psychology 

are devoted to the more recent developments of psychotherapy, 
and to the medical specialists who have placed it on its present 
scientific foundations. Mr. Bruce does not fail to emphasize 
the essential supremacy of "psychic re-education" in the success- 
ful method of to-day's practice, nor the claims of Morton Prince 
in this direction. "In reahty," he says, the "palm should be 
awarded to Dr. Prince, who was making use of psychic re-education 
as early as 1890, and as long ago as 1898 published a detailed 
explanation of its principles and warmly advocated its use in 
the treatment of neurasthenia and otherwidely prevalent nervous 
disorders." "...the labors of Janet, Freud, Prince, Sidis, and 
their fellow psychopathologists have opened a new era in the 
practice of medicine." 

Two paragraphs in these two chapters are so important, and 
withal so well put, that we may venture to quote them, especially 
since they illustrate the author's excellent judgment in general: 
"Both the scientific psychotherapist and the faith healer make use 
of suggestion to attain their ends. Both get results, for the reason 
that suggestion even when utilized by an untrained practitioner 
is frequently powerful enough to bring about seemingly miraculous 
restorations to health. But whereas the non-scientific psycho- 
therapist, with few exceptions, applies suggestion indiscriminately 
to all manner of diseases, the scientific psychotherapist recognizes 
that it is by no means a cure-all, and that even in cases where it is 
beneficial a thorough, accurate diagnosis is often indispensable to 
a perfect cure." 

The fourth chapter deals with "Hypnotism [as] a Therapeutic 
Resource," and the fifth with "Secondary Selves," in an interesting 
but generally familiar way. 

Applied psychology, next briefly discussed ("Psychology and 
Every-day Life"), (but to a wholly inadequate extent, save for a 
magazine article, which in fact it is), "surely does not need a 
prophet to foresee that it has a wonderful future before it." 

The next chapter ("Half a Century of Psychical Research") 
is certainly one of the best summaries of the present status of this 
great question that can be found. It brings to a focus, for ex- 
ample, the opposition between the telepathists and the true 
spiritualists in a clear way that cannot fail to satisfy and enlighten 
a large number of readers. 

The final essay ("William James — An Appreciation") is 
one more of the many earnest published documents evidencing 
the great and inspiring human heart of the lamented philosophical 
psychologist, who died last August. "He is gone — gone to that 



Reviews 73 

unseen world whose mysteries he so patiently explored in the 
hope that mayhap from the exploration he might gain ' balm 
for men's souls.' " These are good words about one of Nature's 
noblemen, and constitute a fit climax to a book whom very many 
will certainly enjoy, and enjoying profit by. 

Bruce's "Scientific Mental Healing" seems to the present 
reviewer the best for popular perusal of all the books in the market. 

George V. N. Dearborn. 
Tufts Medical and Dental Schools. 



zentralblatt fur psychoanalyse. 
Heft 5-6 

S. 187. Freud. Nachtrage zur Traumdeutung. A short 
contribution on symbolism in dreams. Freud relates several 
dreams from his recent experiences in which the interpretation of 
the symbolism was particularly convincing. 

S. 193. Riklin. Eine Luge. An interesting episode from 
daily life. It concerns a case in which a servant was falsely 
accused of theft, and in which she told a very meaningless lie. 
The article is particularly well worth reading for the fine analysis. 

S. 200. Sadger. 1st das Asthma bronchiale eine Sex- 
UALNEUROSE.^ It has long been known that many cases of bron- 
chial asthma belong to the anxiety neurosis group. Sadger gives 
here a detailed analysis of such a case. He maintains that asthma, 
neurotic oedema, membranous colitis, etc., are not strictly speaking 
of psychogenic origin, but are instances of the condition recently 
termed by Freud "sexual neurosis," where the physical pre- 
disposition (of a sexual nature) plays the essential part in the 
aetiology. 

S. 214. Alfred Adler. Beitrag zur Lehre vom Wider- 
stand. Adler traces the patient's resistance to the doctor funda- 
mentally to the contempt for femininity. 

S. 220. Stekel. Die psychische Behandlung der Epilep- 
siE. After some general remarks on the subjects Stekel relates 
the analysis of four cases. He concludes that many cases of so- 
called epilepsy are of psychogenic origin and curable by means of 
psycho-analysis. The characteristic of the repressed tendencies 
is their criminal nature (derived from sexuality); the attacks re- 
place criminal outbursts. 

S. 235. Hitschmann. Ein Fall von Symbolik fur Un- 
GLAUBiGE. A convincing example of dream symbolism. 

S. 236. Stekel. Eine infantile Sexualtheorie. An ex- 
ample of the harmful results of non-enlightenment of children. 



74 The Journal of Abnormal Psychology 

S. 236. Stekel. Beobachtungen aus der Kinderstube. 
Brief analysis of a dream which led to the recovery of childhood 
memories on the subject of Divine punishment, and the origin 
of these. 

S. 237. Hans Sachs. Ueber Wort-Neubildungen. Tak- 
ing a recent book by Spitzer as text, the writer discusses in the 
light of Freud's views many interesting examples of neologism 
formation from famous authors, and deals with the question of 
their classification. 

S. 242. Eibenschutz. Ein Fall von Verlesen im Betrieb 
DER PHiLOLOGiscHEN WissENSCHAFT. Analysis of a striking 
occurrence where a philological authority had read the wrong date 
of a passage (MCCCL instead of MDCCCL), with a consequent 
confusion in his judgment. 

Ernest Jones. 



Heft 7-8 

Rosenthal. Karin Michaelis: Das ^' gefdhrliche Alter" im 
Lichte der Psychoanalyse. S. 277. Michaelis's book, translated 
into English under the title "The Dangerous Age," has aroused 
a widespread interest. Rosenthal gives here a study of it in the 
light of psycho-analysis. By means of careful comparison of the 
book with others by the same authoress, she dissects the opinions 
in it and traces many of them to personal complexes of the writer 
as revealed in the general trends of her work. Those who are 
interested in the book are recommended to read this detailed study. 

Stefan von Maday. Der Begriff des Triebes. S 295. 
General considerations on the nature of instinct, biologically 
regarded, with its relation to will and other mental processes. 

VoN Luzenberger. Psychoanalyse in einem Falle von 
Errotungsangst als Beitrag zur Psychologie des Schamgefuhls. S. 304. 
A short analysis of a case of blushing-phobia. The writer makes 
some general remarks on the subject of the development of modesty 
and shame, and calls special attention to the importance of ex- 
cremental acts in this connection. 

Juliusburger. Ueber einen Fall von akuter auto psyc his c her 
Bewusstseinsstorung, ein Beitrag zur Lehre von Kriminalitdt und 
Psychose. S. 308. A study of an interesting case of what might 
be described as double personality, where the patient suddenly 
disappeared and behaved in a way foreign to his usual character. 
It has many points in common with a similar case described by the 



Reviews 7S 

reviewer In this Journal (Vol. IV, p. 218). The careful analysis 
of the patient's motives and general mentality oifers an agreeable 
contrast to the cursory way in which such cases are often reported. 
The author has also much to say on the subject of criminality, 
which he regards as arising, in the same way as mental disorders 
do, from unconscious wish-phantasies. 

RosENSTEiN. Julius Pikler^s '^ dynamische Psychologic^^ 
und ihre Beziehungen zur Psychoanalyse. S. 316. A general ac- 
count of Pikler's psychology, which has proved itself to contain 
many fertile conceptions, and a study of the aspects in which it 
comes into contact with psycho-analytic work. 

Epstein. Beitrag zur Psychopathologie des Alltagslebens. 
S. 326. Four analyses of defects in mental functioning in everyday 
life (lapsus linguae, losing of objects, etc.) 

Stekel. Ein Fall von Schreibstottern. S. 328. An analysis 
of a case of writing-stammering, a term used to denote a symptom 
in regard to writing that has every analogy with stuttering of 
speech. The symptom was clearly shown to consist in a sexuali- 
zation of the act of writing (a fairly common occurrence) and it 
represents a mental equivalent of psychical impotence. 

Otto Rank. Belege zur Rettungsphantasie . S. 331. This 
is a valuable contribution to the important subject of "saving- 
phantasies," the infantile sources of which have recently been 
pointed by Freud (Psychoanalytisches Jahrbuch. Band II. 
II e Halfte); part of the subject has been described by the reviewer 
in an article entitled "A Forgotten Dream" published in this 
Journal. Rank presents here a study of several historical cases, 
and further illuminates the subject with personal considerations. 

WuLFF. Kleine Beitrdge aus der psychoanalytischen Praxis. 
S. 337. Five short analyses of certain symptoms and sym- 
bolisms. 

PuLAY. MissglUckte Gratulation. S. 342. A short analysis 
of a lapsus calami. 

Heft 9 

Stegmann. Ergebnisse der psychischen Behandlung einiger 
Fdlle von Asthma. S. 377. After briefly referring to several 
cases of asthma, Stegmann gives a fuller account of two typical 
ones. He concludes that asthma is a neurosis, a form of anxiety- 
hysteria, and therefore amenable to psycho-analytic treatment. 

Maeder. Zur Entstehung der Symbolik im Traum, in der 
Dementia Praecox, etc. S. 383. An interesting general account, 
illustrated by many examples of the nature and occurrence of 



IS The Journal of Abnormal Psychology 

symbolism. The article, which should be read in the original, 
contains also a comparison of the processes known as exterioriza- 
tion and introjection. 

Ferenczi. Ueher ohszone Worte. S. 390. This is an article 
of exceptional importance. It is concerned with the psychical 
significance not of obscene ideas, but of obscene words, a subject 
hitherto neglected out of obvious reasons. In actual analysis, 
however, the importance of it forces itself on the observer. Certain 
taboo words are so integral a part of various complexes that the 
accompanying resistances cannot be overcome without dealing 
with the words themselves. Ferenczi propounds a plausible 
hypothesis to explain the peculiar characteristics attaching to 
such words; according to this there is a disturbance of a special 
sort in the development of speech, owing to which these words 
retain certain infantile attributes in the same way that Freud has 
shown visual memories do. 

Adler. Syhiplidophobia. S. 400. This paper is intended 
as a contribution to the significance of phobias and of hypochondria 
in the dynamics of the neuroses; stress is laid on what the author 
terms the Sicherungstendenz of neurotics. 

Freud. Bin Beitrag zum Verges sen von Eigennamen. S. 407. 
An analysis of some instances of the forgetting of proper names. 

Rank. Zum Thema der Zahnreiztrdume, S. 408. An analy- 
sis of a "toothache" dream, confirming Freud's view that such 
dreams relate to masturbation. 

Epstein. Zur Differentialdiagnose organischer und psy-. . 
chogener Erkrankung; zugleich ein Beitrag zur Symbolik von Rechts 
undLinks. S.411. An analysis illustrating the diagnosis between 
hysteria and organic disease, and the symbolic significance of the 
ideas of right and left. 

Sachs. Zur Darstellungs-Technik des Traumes. S. 413. A 
dream-analysis illustrating the employment of somatic stimuli 
in the formation of the dream, and the function of the latter in 
preventing the stimuli from disturbing sleep. 

Stekel. Bine merkwurdige Symptomhandlung. S. 414. An- 
alysis of a particular symptomatic action. 

Heft 10-11 

RiKLiN. Ueber einige Probleme der Sagendeutung. S. 433. 
This paper contains an interesting discussion of certain problems 
in connection with the interpretation of myths. The material 
considered is chiefly taken from Laistner's well-known work, and 
.thus concerns myths built on the analogy with nightmare experi- 



Reviews 77 

ences. Riklin discusses such matters as the transformation- 
capacity of demons, the methods of guarding against them, the 
beliefs in the evil eye, various types of symbolisms, and so on. 

SiLBERER. Vorldufer Freud'scher Gedanken. S. 441. Sil- 
berer points out a number of instances in which older authors had 
already given utterance to ideas that we couple with the name of 
Freud. He cites in particular Schelling, Bulwer Lytton, Kerner, 
and Wagner. 

Otto Rank. Das Verlieren als SymptQmhandlung. S. 450. 
Rank gives here a long and detailed analysis of an instance of 
"accidental" losing of a valuable object, and shows, especially 
by means of dream analysis, the complicated series of mental pro- 
cesses that lay behind the act; his interpretations received striking 
external confirmations. 

Ferenczi. Anatole France als Analytiker. S. 461. Feren- 
czi here relates a number of remarkable passages from Anatole 
France that show a keen insight into many of the mechanisms 
since demonstrated by psycho-analysis. 

Pfister. Hysterie und Mystik bei Margaretha Ehna. S. 468. 
Pfister, a Zurich clergyman, presents here a long psycho-analytic 
study of the mentality of a celebrated mystic. It is a detailed 
contribution to the close relation between sexuality and 
religion. 

Friedmann. Eduard Morike. S. 486. A discussion of some 
passages from the famous poet Morike having a direct bearing on 
certain problems of psycho-analysis. 

Stekel. Zur Psychologie des Exhihitionismes . S. 494. This 
is an important contribution to the psychogenesis of exhibitionism, 
the commonest of all sexual perversions, and one that plays a 
part in the majority of cases of neurosis. Stekel relates it in 
particular to an unconscious narcissism. 

Ernest Jones. Ein Beispiel von literarischer Verwertung 
des Versprechens. S. 496. A quotation of several passages from 
Meredith's Egoist that reveal a complete appreciation of the 
significance of slips of the tongue. 

Meisl. Ein Fall von Namenvergessen. A neat analysis of a 
case of a name-forgetting. 

Reik. Zur Rettungssymbolik. S. 499. Discussion of a dream 
related by Flaubert, which shows a "saving phantasy" of the type 
explained by Freud. 

VoN Hartungen. Die Psychoanalyse in der modernen 
Literatur. S. 499. Some passages from Heinrich Mann dealing 
with psycho-analytic problems. 



78 The Journal of Abnormal Psychology 

Reik. Aus Gustav Flauberts Werken. S. 501. Quotations 
of several contrlbutioms of Flauberts to psychological questions. 

Heft 12 

James J. Putnam. Personliche Erfahrungen mit Freuds 
psychoanalytischer Methode. S. 533. Reprint of Dr. Putnam's 
paper published in the Journal of Nervous and Mental Disease, 
November, 1910. 

Karl Abraham. Einige Bemerkungen uber den Mutterkultus 
und seine Symbolik in der Individual — und Folkerpsychologie. 
S. 549. Some short notes on phantasies relating to the mother's 
body. Of especial interest is Abraham's account of a cult devel- 
oped by a local religious sect in Russia that strikingly confirms 
a given symbolism the interpretation of which had previously been 
made from dream-analyses. 

Dattner. Eine historische Fehlleistung. S. 550. Dattner 
describes at length the occurrence of a very remarkable example 
of an "accidental" forgetting to insert an all-important word in the 
law separating the financial relations of Austria from those of 
Hungary. The matter is not yet settled, but the omission of the 
word will cost Austria between eleven and fifty-two million crowns. 
The tendency that unconsciously determined the error was the 
desire of Hungary, incorporated in her representatives, to profit 
at the expense of Austria. 

Drosnes. Eine psychoanalytische Organisation zur Ver- 
hutung von Selbstmorden. S. 553. Drosnes discusses the rather 
Utopian possibility of establishing an organization for the pre- 
vention of suicide, by means of which despairing individuals could 
be referred for psycho-analytic treatment. It is now known that 
the motives of suicide are only in part conscious; no one commits 
suicide unless the conscious motives (poverty, disappointment in 
love, fear of disgrace, etc.) are reinforced by deeper unconscious 
conflicts which the person cannot solve. Every one with experi- 
ence of the treatment knows how suicide can in this way be pre- 
vented, and there is reason to believe that the conclusion could be 
generalized. But the gulf between ability to help and oppor- 
tunity to help is not to be bridged in our present society. 

Ferenczi. Reizung der analen erogenen Zone als auslosende 
Ursache der Paranoia. S. 557. Such an occurrence must sound 
most unlikely to those who are unaware of the essential causes of 
paranoia. Freud has shown that paranoia is a perverted expres- 
sion of homosexuality, a condition which is perhaps constantly 
accompanied by over-sensitiveness of the anal erogenous zone. 



Reviews 79 

Ferenczi relates a case In which a local irritative lesion seemed to 
play the part of an important exciting factor in the development 
of the psychosis. 

Heller. Beitrag zur Genesis der Todesahnungen. S. 560. 
Forebodings of death may take their origin in some unconscious 
attraction towards death (suicide Ideas). The case here reported 
does not, however, seem to bear out the author's views. 

Ed. Hitschmann. Beitrdge zur Sexualsymbolik des Traumes. 
S. 561. Four short dream-analyses illustrating particular sym- 
bolisms. 

Ernest Jones. Das Problem des " Gemeinsamen Sterhens" 
namentlich mit Bezug aufden Selbstmord Heinrich von Kleist's. S. 563. 
Some persons have a passionate longing to die together with some 
one they love, the German poet, Von Klelst, being a notable ex- 
ample of this. The motives underlying the desire are very com- 
plicated, and an attempt Is made here to unravel the deeper ones. 

C. G. Jung. Ein Beitrag zur Kenntnis des Zahlentraumes. 
S. 567. A detailed analysis of the determinants of the figures 
occurring in two dreams, and showing clearly how complicated 
are the manipulations of figures that go on in the unconscious. 

Maeder. Ueber zwei Frauentypen, S. 573. Two sexual 
types of women are commonly distinguished in the literature, 
known respectively as the clitoris type and the uterus type. 
Maeder gives a description of the characters of the two types, and 
discusses the psychogenesis of them. The former is characterized by 
identification with the father, the latter by Identification with the 
mother. 

Marcinowski. Eine kleine Mitteilung. S. 575. Analysis 
of a neologism experienced in the state between sleep and waking. 

Otto Rank. Zum^'nachtrdglichenGehorsam.'^ S. 576. This 
term Is used to denote obedience to a long-past command uttered 
by some one In authority; post-hypnotic suggestion is an example 
of It (see Journal of Abnormal Psychology. Vol. V., p. 222.) 
Rank discusses in the light of two instances the employment of the 
conception In mythology and folk-lore. His Interesting analyses 
throw light upon certain manifestations of the neuroses. 

Reitler. Kritische Bemerkungen zu Dr. Alfred Adler^s 
Lehre vom " mdnnlichen Protest^ S. 580. This is a clearly written 
criticism of Adler's view that a fundamental process in the forma- 
tion of neuroses is the desire to become masculine and to despise 
all feminine tendencies. 

Robitsek. Die Stiege, Leiter als sexuelles Symbol in der 
Antike. S. 586. Doubt has been cast on Freud's interpretation 



80 The Journal of Abnormal Psychology 

of the occurrence in dreams of climbing steps or ladders as a symbol 
for coitus, and Robitsek brings here evidence from archaeology- 
showing that this symbolism was well understood by the ancients. 

RosENSTEiN. Beziehungen von Traum und Witz. S. 587. 
An instance of the close resemblance between dreams and wit (see 
Brill, Journal of Abnormal Psychology, October, 1911). 

Sachs. Ein Fall intensiver Traurnentstellung. S. 588. An- 
alysis of a dream neologism formed in a complicated way. 

Sadger. Beitrdge zur Sexualfrage. S. 589. Some experi- 
ences of the development of sexual ideas in children. 

Wm. Stekel. Einige Bemerkungen zur Rettungsphantasie 
und die Analyse eines Rettungstraumes. S. 591. Stekel gives here 
an analysis of a dream containing a "saving-phantasy," and calls 
attention to the fact that it signifies not only an incestuous desire 
in regard to the parent but also a death-wish. 

Wagner. Ein kleiner Beitrag zur ^^ Psychopathologie des 
Alltagslebens.^' S. 594. Analysis of a mistake in reading the 
wrong word, with the determining motives. 

Ernest Jones. 



JAHRBUCH fur PSYCHOANALYTISCHE UND PSYCHOPATHOLO- 

GiscHE FoRSCHUNGEN. Band II. Halfte II. 

S. 389. Freud, beitrage zur psychologie des liebes- 

LEBENS. 1. UEBER EINEN BESONDEREN TYPUS DER OBJEKT- 

wahl beim manne. As is generally recognized, choice in love 
is never quite free; for every one there are certain features in the 
opposite sex that particularly attract him, and in the absence 
of which he does not fall in love. With some people these "condi- 
tions" of love are much more specific and sharply defined than 
with others. Freud here describes a special type whose love 
affairs show the following characteristics: 

1. Early in life a striking separation is efi'ected between two 
extremes, so that they are only attracted by either, on the one 
hand, an exceedingly pure, idealistic type of woman, about whom, 
they do not venture to have sexual thoughts, or, on the other hand, 
by the commonest kind of women, particularly prostitutes. 

2. They cleave to their mistress with the greatest fidelity, 
and cannot bring themselves to part from her. Once having 
done so definitely, however, they show a tendency to develop a 
series of love afifairs, in each of which their attitude is exactly that 
just mentioned. 

3. They are interested only in women who are not free, but 



Reviews 81 

who already belong to another man (engagement or marriage), 
and who (4) have a bad reputation In sex matters. 

5. They have the craving to win such a woman's love, In 
order to rescue or save her. 

Theseseem very disparate characteristics for one man to have, 
but Freud shows that they are not disconnected, as they at first 
sight appear, but that they have a common origin, and are merely 
dlfi^erent manifestations of the same underlying tendency. He 
gives a very Interesting study on the meaning and development of 
each of these characteristics. 

S. 398. Rosenstein. die theorien der organminder- 

WERTIGKEIT UND DER BISEXUALITAT IN IHREN BEZIEHUNGEN ZUR 

neurosenlehre. Several years ago Adler published a book, the 
main thesis of which was that certain maladies, Including the neu- 
roses, originate In defective development of particular organs 
(eye, heart, bladder, etc.), which from general sensitiveness, and 
in other ways, obtained an excessive psychical importance. At the 
same time Fliess In another book traced the same group of maladies 
to an Incomplete differentiation of the two opposite components 
of the normal bisexual predisposition. Rosenstein here points 
out how the two views supplement each other, and make possible 
a deeper Insight into the origin of the neuroses. 

S. 409. Sadger. ueber urethralerotik. This Is a highly 
important contribution to the subject, first opened by Freud, of 
Individual erogenous zones. Sadger describes how the act of 
micturition may become closely associated with sexuality, and dis- 
cusses at length the results of this in childhood phantasies. In later 
specific character-reactions, and In Individual neurotic symptoms; 
many such symptoms, e. g., enuresis, pollutions, psychical Im- 
potence, etc., cannot be properly understood without taking Into 
consideration this their deepest source. The article deserves 
careful study. 

S. 451. Robitsek. die analyse von egmonts traum. 
An interesting and clearly written study of an episode in Goethe's 
Egmont, namely, the hero's dream on the night before his execu- 
tion. Through the dream the frightful depression at the thought 
of the morrow's event Is changed Into an ecstatic exaltation of 
triumph. Robitsek analyzes the Individual features of the dream, 
and shows how the symbolism of freedom, victory, and so on, are 
transformations, suitable to the urgent occasion,, of various pre- 
existing unconscious phantasies. The function of the dream In 
replacing one mood by Its opposite is particularly evident. 

S. 465. Otto Rank, ein traum, der sich selbst deutet. 



82 The Journal of Abnormal Psychology 

This is the fullest, and one of the most valuable, dream analyses 
yet published; It occupies seventy-six pages. The dream itself 
was remarkable In the fact that the second half of It, dreamed later 
in the same night, constituted a complement of the first, and, as 
the writer says, interpreted Itself. Those who doubt the validity 
of Freud's theory of dreams are recommended to read this Impor- 
tant paper. 

S. 541. Silberer. phantasie und mythos. This Is a de- 
tailed study of the precise psychological characteristics of phan- 
tasy, myths, religion, and allied subjects; the conclusions cannot 
be shortly stated. 

S. 623. Bleuler. die psychanalyse freuds. This has 
also been published In book form, so that a separate review of it 
will be given. 

S. 731. Otto Rank, bericht uber die zweite psycho- 

ANALYTISCHE VEREINIGUNG IN NURNBERG, MARZ, 1910. An 

abstract of the papers read at the second international congress for 
psychoanalysis. 

S. 743. Jung. zuR KRiTiK UBER PSYCHOANALYSE. A polem- 
ical article on various criticisms of psychoanalysis. 

Ernest Jones. 

jahrbuch fur psychoanalytische und psychopatholo- 
GiscHE FORSCHUNGEN. Band III. Erste Halfte. 1911. 

Freud. Formulierungen Uber die zzvei Prinzipien des psy~ 
chischen Geschehens. S. I. 

This short paper is one of Freud's characteristic cameo-like 
productions in which Is presented In a highly condensed form the 
results of years of thought and study. It is one of his most 
valuable contributions to pure psychology, but it is exceptionally 
hard to render the gist of It In an abstract, not only because it 
itself Is written in almost abstract form, — it is only seven pages 
long, — but also because it is based on the most difficult part 
of his psychology, as expounded in the last chapter of the Traum- 
deutung. Freud here formulates mental activities in terms of two 
main principles, the pleasure principle and the reality principle. In 
the neuroses the preponderance of the former, the withdrawal 
into a life of phantasy away from too painful reality, has been 
noted by a number of observers (compare Janet's work on the 
failure of the fonction du reel). Freud regards the pleasure prin- 
ciple as the primary and fundamental one, characteristic of the 
mental life of the child and of primitive man. It is gradually 
replaced by the reality principle, on account of the greater prac- 



Reviews 83 

tical value of the latter. Mankind is loath, however, to renounce 
the former altogether, and not only returns to it under certain 
circumstances (disappointment with actual life, etc.), but has to 
allow it a certain place in his regular mental life (the analogy of 
Yellowstone Park being preserved from the effects of civilization 
is here adduced). In the light of this development Freud then 
discusses the effects of it, and the nature and genesis of various 
mental attributes, such as consciousness, memory, judgement, 
attention, thought, and so on. The bearing of the conception 
on the aims and nature of science, religion, education, and art is 
also pointed out. 

Freud. Psychoanalytische Bemerkungen liber einen auto- 
hiographisch heschriebenen Fall von Paranoia {Dementia paranoides). 
S.9. 

This detailed study of the psychological problems of paranoia 
ranks at the side of the two monographs on anxiety-hysteria and 
the obsessional neurosis that Freud has published in earlier num- 
bers of the Jahrbuch. In it is put forward a complete psycholog- 
ical theory of paranoia. It is illustrated by a lengthy considera- 
tion of the well-known autobiography published not long ago by a 
victim of the disease, Dr. Schreber. According to Freud, and 
on the basis not only of his own analytic experience but also that 
of Jung and Ferenczi, the chief mechanism responsible for the 
symptom-formation in paranoia is that of projection, the central 
conflict concerns a homosexual wish-phantasy, and the character- 
istic of the disease lies in the peculiar mode of defence adopted 
against this repressed phantasy. In the passage of the normal 
child from auto-erotism to object-love there is a stage in which, 
when the auto-erotic impulses are being grouped into a unity so 
as to seek an external object, the first object utilized is the in- 
dividual himself, a condition known as narcissism. The passage 
from this to normal heterosexuality leads over homosexuality, i.e.^ 
the choice of an external object having attributes similar to those 
of the individual in question. At any stage in this normal develop- 
ment an arrest or fixation may take place, an event of great sig- 
nificance for his later life and especially for the choice of any neu- 
rosis into which he may later fall. Neurosis essentially signifies 
a withdrawal of the subject from an over-painful reality, and a 
return to the phantasies, now unconscious, of childhood. In 
dementia praecox, a disease for which Freud here suggests the name 
paraphrenia, Jung and Abraham have shown that what happens 
is a return to primitive auto-erotic activities. In paranoia the 
arrest of development takes place at a later stage, so that the 



84 The Journal of Abnormal Psychology 

return is to a life of phantasy concerning narcissism and homo- 
sexuality. Freud agrees with Kraepelin that most cases labelled 
paranoia belong to the dementia praecox group, but to him it is 
largely a matter of the degree to which the higher inhibitions fall 
away. We thus have a psychological explanation of the clinical 
observation that most cases of paranoia later on in their course 
become typical cases of dementia praecox. The first falling away 
of inhibitions uncover the homosexual tendencies, the next the 
narcissistic, and finally when the earliest inhibitions are abro- 
gated there is a return to the primitive condition of auto-erotism. 
This schematic and lineal presentation is here simplified for ab- 
stracting purposes; it does not take sufficient account of the morbid 
fixations at various stages. 

Freud regards the chief delusions of paranoia as difi"erent 
kinds of contradiction of a single sentence "I love him," which 
may for convenience' sake be taken to represent the homosexual 
wish of a male patient, (a) The delusions of jealousy, so fre- 
quent in, for instance, alcoholic paranoia, contradicts the subject 
of the sentence. The wish is projected on to the wife, so that the 
transformation runs, *'It is not I who love him, it is she who loves 
him," with the result that he suspects his wife in regard to various 
men (originally the ones he loved himself, (b) The delusions of 
persecution contradict the verb of the sentence. As is elsewhere 
so common, the love is transformed into hate, producing the 
result, "I hate him." The paranoia mechanism projects this 
on to the exterior, so that it runs "He hates me," which then gives 
him the right to hate in return. Observation shows that the per- 
son who is supposed to hate the patient is some one who has 
previously been loved by him, or else a simple replacement of such 
a person, (c) The erotic delusions contradict the object of the 
sentence. The love is transposed from its homosexual object to a 
heterosexual one, but is not experienced directly as an inner feeling 
of love as it is in the normal. It is projected on to the object in 
question and returns to the patient as a delusion that she loves him, 
the common form of the paranoiac delusion that various women 
are in love with the patient, (d) The grandiose delusions con- 
tradict the whole sentence, which thus reads, "I don't love any 
one at all," which, as the love must find some outlet, is equivalent 
to the sentence, "I love only myself." Thus arises the over- 
estimation of the patient's personal charms, powers, and attri- 
butes, a symptom which to some extent is always present, and 
which indicates a return to the infantile stage of narcissism re- 
ferred to above. 



Reviews 85 

Freud adds some Important general considerations on the 
significance of delusion-formation. He regards this not as a sign 
of disease, but as a recovery-process, an attempt to reconstruct 
the disturbed conception of reality. He views paranoia as the 
result of a breaking down of the sublimation of homosexuality, 
with a consequent regression to the fixation stage of narcissism 
No abstract, however, can do justice to the clear and detailed 
exposition of these and similar problems. 

Bertschinger. Illustrierte H alluzinationen. S. 69. 

Bertschinger publishes here a series of drawings made by an 
insane patient, and correlates them with the results of a long 
analytic study. It was doubtful whether the case was one of 
exceptionally severe hysteria, or of dementia praecox. The draw- 
ings show a striking resemblance to the classical conceptions of 
mythical beings, half men, half animal, etc. The study is one of 
unusual interest, and is very lucidly presented. 



Ferenczi. Ueber die Rolle der Homos exualitdt in der Path- 
ogenese der Paranoia. S. 101. 

Ferenczi expounds from rather different points of view Freud's 
theory of paranoia referred to above, in the development of which 
he has himself played a considerable part. He details the analysis 
of four personally studied cases In support of this theory, and adds 
several Important considerations of his own. 

Jung, Wandlungen und Symbole der Libido. S. 120. 
Die psychologische Entrdtselung der religiosen Glossolalie und der 
automatischen Kryptographie. S. 427. Consideration of these two 
articles will be postponed until their conclusions have appeared 
in the succeeding volume of the Jahrbuch. 

BiNSWANGER. Analyse einer hysterischen Phobie. S. 228. 

Binswanger, to whom we owe the most detailed analysis of 
hysteria that has yet been published (in Band I of the Jahrbuch), 
here gives an analysis, eighty-one pages long, of a typical fixed 
hysterical phobia. It Is Impossible to describe this In abstract, 
but the article, which Is a very convincing study, should be read 
In the original by all those interested in the genesis of such con- 
ditions. 

Jung. Morton Prince, M.D. The Mechanism and Inter- 
pretation of Dreams. S. 309. 

This Is a detailed discussion of the article published by Dr. 
Prince in the Journal of Abnormal Psychology, Vol. V, No. 4. 
Jung congratulates him on being open-minded enough not to 
reject Freud's theory of dreams before attempting to put it to the 



86 The Journal of Abnormal Psychology 

test of experience, but he expresses his regret that Dr. Prince 
did not find it necessary to employ the method recommended by 
Freud for this purpose, namely psycho-analysis. Dr. Prince's 
study only illustrates once more the fact that we possess no other 
method capable of penetrating into the problems concerning the 
genesis of dreams. This is not stated as a mere assertion, for 
Jung, by carefully going over the material published by Dr. Prince, 
attempts to demonstrate the incompleteness of the study. He 
points out in great detail how many matters are left unexplained 
by Dr. Prince, data omitted from motives of discretion, and 
questions of the utmost importance left unanswered. He also 
mentions obvious inferences to be drawn from the material, giving 
thus a partial interpretation of the dreams published. Any one 
desirous of coming to an opinion about dream problems on the 
basis of Dr. Prince's study will therefore have to read this criticism 
if he wishes to be impartial in the matter. 

Spielrein. Ueber den psychologischen Inhalt eines Falles 
von Schizophrenie {Dementia praecox). S. 329. 

This is a very lengthy casuistic contribution to the psychology 
of dementia praecox. Of especial interest is the striking resem- 
blance between the productions of the psychosis and various . myth- 
ological beliefs of classical times. 

Rank. Ein Beitrag zum Narcissismus. S. 401. 

This is an interesting contribution to the subject of narcis- 
sism, on the basis of three fully analyzed dreams of a normal person. 
Rank points out a number of ways in which narcissism comes to 
expression in mythology, literature, and daily life. 

Bleuler. Eine kasuistische Mitteilung zur kindlichen Theorie 
der Sexualvorgdnge. S. 467. 

Bleuler shortly narrates an experience confirming Freud's 
opinion that children often imagine babies to be formed out of 
excremental material and to issue from the mother's body in the 
same way that this does. 

Bleuler and Jung. Zur Theorie des schizophrenen Nega- 
tivismes. S. 468. A discussion between Bleuler and Jung on the 
former's theory of the nature and genesis of negativism in dementia 
praecox. 

Maeder. Psychoanalyse bei einer melancholischen Depres- 
sion. S. 479. An author's abstract of a case-analysis of melan- 
cholic depression published in the Zentralblatt fur Nervenheil- 
kunde und Psychiatric, 1910. 

Ernest Jones. 



87 

SOCIETIES 

International Association for Medical Psychology and Psychotherapy. 

The second annual meeting of this association was held at 
Munich on the 25th and 26th of September, 1911, under the 
presidentship of Dr. Oskar Vogt. There were between thirty and 
forty members present. A symposium was held on the subject 
of hypnotism, and a considerable number of individual papers 
were also read. As before, the discussions were at once translated 
from one language to another, so that every one could follow the 
various speakers. 

The hypnotism symposium was opened by Bernheim and 
Claparede, whose communications had for greater convenience 
been already published in the Journal fiir Psychologic und Neu- 
rologic (Band XVIII). The discussion was divided by the Council 
under the following headings: 1. Nature of Hypnosis. Specific 
character of hypnosis; objective evidences of this; relation to simu- 
lation and to sleep. II. What modifications of consciousness and of 
the nervous system characterize hypnosis? Nature of these and rela- 
tion of them to suggestion; comparison between them and the 
depth of the hypnosis; psychological features, such as changes in 
memory, association-reactions, attention, and mental capacity. 
III. Production of Hypnosis. Frequency with which people can 
be hypnotized; psychical relation between patient and hypnotizer; 
mechanism of suggestion. IV. Biological Significance of Hypno- 
sis. Relative antiquity of hypnosis and sleep; occurrence in 
animals; usefulness in nature. V. Therapeutic Value of Hypnosis. 
Possible ethical or medical contraindications of hypnotism; relative 
value of waking and sleeping suggestion; precise indications for 
and aims of hypnotism. Each of these headings were subdivided, 
so that a great share of the time had to be spent in deciding whether 
a given remark belonged to this or that sub-heading. The whole 
subject was worked over, and several hours spent in discussing 
the problems in detail. It is hard to say that there was any 
fruitful result, for not only was there no new point of view brought 
out in the discussion, but every one seemed at the end to be of 
the same opinion as when he started. We heard Bernheim give 
his same intellectualistic definition, Forel maintain that hypnotism 
and suggestion was throughout identical and not to be distinguished. 
Self state the psycho-analytic view that both suggestion and 
hypnotism are dependent on the personal relation between the 
patient and the hypnotizer, and so on. A more sterile discussion 
surely never took place. The chief, perhaps the only, value of the 



88 The Journal of Abnormal Psychology 

symposium was the publication by Claparede of a luminous article 
(referred to above) which, although it contributes little of positive 
value, gives an excellent review of the matter and a neat definition 
of the problems concerned. 

Another subject debated at length was that of dreams. 
Tromner read a paper on this and subdivided the subject for dis- 
cussion into (a) methods, (b) definition, (c) development, (d) details 
of dream life, (e) relations between dreams and waking life, 
(f) causes of dreams. As apparently no one else had any experi- 
ence to bring forward the debate resolved itself into a duel between 
Tromner and the psycho-analysts present, which degenerated into 
a fusillade of repartee. 

Frank, in a paper on the determination of neurotic symptoms 
in the subconscious, proposed an amalgamation of the hypnotic 
and psycho-analytic methods of treatment. He was supported 
by Forel, but no one else was willing to listen to any compromise. 
Of the other papers maybe mentioned one by Dupre on hysteria 
and mythomania, one by Kohnstamm on a psycho-biological 
theory of consciousness, and one by Delius on the hypnotic treat- 
ment of nervous asthma. 

The meeting of 1912 will take place in September, at Zurich. 
Bernheim was elected president. Von Hattenburg, secretary, and 
Forel, Ernest Jones, Semon, Seif, and Vogt members of the council. 
The two impressions the present writer received from attending 
the congress were the lack of novelty in any work done outside 
the psycho-analytic school, and the difficulty of finding a common 
ground where matters can be discussed by different schools. 

Ernest Jones. 

BOOKS RECEIVED 

PSYCHOLOGY OF THE RELIGIOUS LIFE. By Georgc Mulcolm 
Stratton. George Allen & Company, Ltd., London. 1911, pp. 367. 

MOTIVE FORCE AND MOTIVATION TRACKS. By E. Boyd Barrett. 
S. J. Longmans, Green & Company, London. 1911, pp. 225, 
7-6 net. 

l'analyse physiologique de la PERCEPTION. Par Edouard 
Ahramowski. Bloud & Cie. Paris, France. Pp. 120. 

la SUGGESTION ET SES LiMiTES. Par Professeur Bajenoff et 
D'Ossipojff. Bloud & Cie. Paris, France. Pp.117. 

LA PSYCHOLOGiE DE l'attention. Par N. Vaschide et Ray- 
mond Meunier. Bloud & Cie, Paris, France. Pp. 198. 

OBSCENE LITERATURE & CONSTITUTIONAL LAW. By Tkeodore 

Schroeder. Privately printed. New York, 1911. Pp. 424. 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



JUNE-JULY, 1912 



CRITIQUE OF IMPURE REASON* 

BY FREDERIC LYMAN WELLS, PH.D., ' 

McLean Hospital, Waver ley, Mass. 

IN our reaction to a broad and distinctive system of 
interpreting mental phenomena, one which makes 
its appeal strongly on grounds of feeling and a sense 
for heuristic values, we must use due care not to for- 
get that the question of its validity is after all a scientific 
one, which should be dealt with upon rational and not on 
emotional grounds. There is in the psychological thought 
of to-day no tendency more subject to this limitation of 
judgment than the doctrines originating in psychoanalysis. 
In these brief remarks it is endeavored to point out some 
special reasons why these doctrines have not had, and in 
their present form ought scarcely to expect, sympathetic 
recognition at the hands of a discriminating psychology. 

As an interpretation of latent mental trends, the key- 
stone of the psychoanalytic structure is symbolism. Its 
most important generalizations depend on the correctness 
of the statement that one mental event is the symbol of a 
certain other one. The essential evidence upon which the 
symbolism is formulated seems to be that of some associa- 
tive connection. Thus if we obey the familiar injunction 
to think of Coca-Cola whenever we see an arrow, the arrow 
might ultimately become in our minds a symbol for Coca- 
Cola. But this does not provide that a thing universally 

*Substantiall7 as read before a meeting of the Boston Society of Psychiatry 
and Neurology, April 18, 1912. 

89 



90 Critique of Impure Reason 

means what it makes one think of. And if by this criterion 
one thing symboHzes another now, would this carry with it 
the assurance that it symbolized, or would have made the 
subject think of, that other thing at some previous time? 
Our associative processes are not invariable, but the same 
idea or external stimulus rouses now one, now an entirely 
different, set of associations, and the associations of one 
time are not a criterion of the associations or symbolisms 
of another. Until it is evident that the method takes some 
precaution against this quite elementary difficulty, psy- 
chology is likely to look askance at its results. It is to be 
gravely questioned whether the psychoanalytic method 
is by its very nature capable of demonstrating the things it is 
claimed to demonstrate, for special example, in its for 
normal psychology most notable application, the dream- 
analysis. 

There is no attempt at a sweeping denial of the sym- 
bolic factor in dreams; but it seems very improbable that 
the free association method is of a character to show, 
retroactively, what these symbolisms truly are. Critical 
users of the method admit a genuine difficulty in the se- 
lection of the precise association from a train of ideas; i. e., 
of "knowing where to stop." If the dream be a wish-ful- 
filling mechanism, condensation, displacement, secondary 
elaboration and dramatization are its four universal joints. 
Nothing approaching in definiteness and universality the 
theory of the wish-fulfilling function in dreams is to be built 
upon evidence of such equivocal character. As Bleuler 
and doubtless others have clearly seen, the essential question 
is whether other material, subjected to similar analysis, 
would not show itself equally symbolic of repressed wishes 
with the individual's dream. And it is by no means a settled 
question whether the same symbolic wish-fulfilment is not 
with similar readiness to be found in material with no direct 
reference to the subject's personality. Under these circum- 
stances such interpretation of dreams were obviously 
meaningless; not fifty thousand, but fifty million dreams 
might be analyzed according to wish-fulfilment. 

And in other phases of psychoanalytic doctrine the 
control procedures are as lacking as they are essential. 



Frederic Lyman Wells 91 

We are told that if we forget something we ought to remem- 
ber, the cause lies in its association with some unpleasant 
experience. Before such a statement acquires significance, 
it must be evident that other ideas are not associated with 
equal closeness to unpleasant experiences. One hesitates 
to regard this as even improbable, in view of the more 
than devious character of the associations in some of the 
classical instances, aliquis, for example. Merely in illus- 
tration of the experimental method as applied to the general 
problem may be mentioned an extensive study of the rela- 
tion of, feeling to memory — that of Peters — in an recent 
number of the Psychologische Arbeiten^ which contains a just 
criticism of the psychoanalytic method in this relation. 

Similar interpretations have been sought for lapses in 
various motor functions. One occasionally meets here 
with what seems a regrettably naive misconception of the 
role of the deterministic concept in psychology. Surely 
every psychologist recognizing a physiological correlate 
of mental phenomena has considered that all reactions, 
purposeful or incoherent, are in the strictest sense "de- 
termined," and would be the last to dispute that "every 
little movement has a meaning all its own," even though it 
were considered that the determining factors lay beyond 
the reach of reliable investigation. The lapses of speech have 
been studied the most, psychoanalysis giving attention 
almost wholly to alterations of the content. This would 
scarcely give a proportioned view, for the purely formal 
lapses of speech are also very common, and from a mechanis- 
tic standpoint, really more interesting. Studies made 
with an experimental attitude have long indicated that dis- 
traction, or inattention, is an essential factor in one and 
all. Given distraction, the lapse may be colored by what- 
ever distracts; immediate introspection can best say what 
this is, but even this not always. It may come from any 
source; immediate context would seem to be the actually 
most frequent one, at least in those of handwriting. Those 
of the typewriter show some interesting peculiarities of 
their own. The "hidden tendency" does not play a very 
great part in these studies. Still, the question is not 
merely whether such factors, as given in the mechanism of 



92 Critique of Impure Reason 

wish-fulfilment and the like, can color the content of the 
lapse. They may, quite obviously and consciously, but it 
does not seem that, when there is no appearance or conscious- 
ness of such mechanism, the present psychoanalytic method 
is suitable foj the valid demonstration of one. The whole 
question of these and the Symptomhandlungen at large 
depends upon the crucial test of whether any unconscious 
factors beyond those of distraction can be demonstrated 
that are not equally present where no Fehlhandlung occurs. 

Many factors contribute to render the teachings of 
psychoanalysis peculiarly liable to favorably or unfavorably 
prejudiced judgment. The subject seems unfortunately apt 
in turning either a man's stomach or his head. Being usually 
concerned with matters that involve considerable intensities 
of personal feeling, objective judgment of results would 
not be of the easiest, even were the psychoanalytic method 
itself less open to criticism on this score. How much of 
Freud one to-day believes is bound to be largely a matter 
of feeling, because the data of the method are so little 
susceptible of valuation upon any other basis. Whatever 
of these theories be true or false, there seem to have been 
but scattered attempts to submit them to the test of ex- 
periential conditions. 

This question of the validity of the psychoanalytic 
method for demonstrating certain mental mechanisms is, 
of course, but a part of the larger questions of the role of 
psychogenic factors in mental disturbances. So far as we 
know there are no mental experiences of a specifically 
pathological nature, but mentally pathological reactions 
to any given situation are determined by the individual's 
constitution or immediate powers of resistance. The ex- 
periential factor in our mental life is an essential determi- 
nant of the content of the mental reactions. But whether 
those reactions are of a healthy or pathological character, 
depends far less upon external situations than upon the 
organism which has to adjust itself to them. The content 
of the maladjustment is of chief importance for the light 
it may throw upon the fundamental conditions that have 
permitted it to take place. 

The tremendous role of sexuality in the Freudian theo- 



Frederic Lyman Wells 93 

ries is largely derived in but doubtful ways, and the exact 
character of its relation to the psychogenesis of various 
pathological conditions must also be regarded as largely 
uncertain. The vita sexualis is indeed the touchstone of 
mental stability; but it does not follow that the failure of 
sexual adaptation is an essential cause, or, in fact, other 
than a frequent or inevitable symptom of neurotic dis- 
turbance. Some psychoanalysts are fond of accounting 
for the non-acceptance of their doctrines on the ground of 
sexual resistances in their opponents, and lay great stress 
on conventional prudery and suppression as a bar to the 
progress of their teachings. But it must not be lost sight 
of that there is a type of personality that would be attracted 
to psychoanalysis by the very prominence it gives to sexual 
factors, its facilities for mental mixoscopia perhaps afford- 
ing to the sexual feelings a not disagreeable stimulation of 
the safer and cheaper sort. There may be applicability in 
both of these assertions, but they scarcely touch the ques- 
tion at issue. The truth or falsehood of a proposition, 
judged by such criteria as scientific progress has been able 
to build up, is a more important question than whether 
certain individuals accept or reject it on other grounds. 
The most rigid control of its observations may not enable 
psychoanalysis to win the respect of all its opponents; but 
this does not absolve those responsible from the duty of 
making an adequate effort to deserve it. 



THE EVOLUTION OF SLEEP AND HYPNOSIS 

BY ISADOR H. CORIAT, M.D., 

Boston^ Mass. 

IN a former contribution* there was discussed the nature 
of sleep, in which it was shown that sleep was due to 
an absence of those peripheral stimuli from the re- 
ceptor organs which normally keep the brain in ac- 
tivity. It was furthermore demonstrated that the motion- 
less states into which animals could be suddenly thrown 
were not sleep but a form of cerebral inhibition, strongly 
allied to hypnosis, if, indeed, not identical with it. These 
experiments on the nature of sleep and hypnosis suggested 
several other directions to which inquiry might be directed 
— namely, 

1. How did sleep and hypnosis evolve.^ 

2. What is the biological necessity for sleep .^ 
Although it has been noted that primitive, moving 

unicellular organisms when observed for hours at a time, 
were unceasingly active and showed no motionless states, 
yet sleep must have arisen at some stage of evolution from 
these primitive organisms. Presumably those organisms 
survived which possessed these motionless states to their 
greatest extent, and from these motionless states could 
probably be traced the phylogenetic origin of sleep. In the 
higher animals, however, that is, in those possessing a com- 
plex nervous fystem, these motionless states, as demon- 
strated by my experiments, were not sleep but a form of 
cerebral inhibition, a genuine hypnosis. Furthermore, the 
animals experimented upon possessed genuine spontaneous 
sleep states, whereas the motionless states induced in them 
were artificial and experimental. 

In the lower organisms these motionless states are not 
intelligent reactions, but probably blind mechanisms, and 
we must therefore not allow the interpretation of such 
phenomena to lead us into anthropomorphism. Neither 
can they be said to arise from fatigue, because such states 

*Isador H. Corlat. The Nature of Sleep. Journal Abnormal Psychol- 
ogy, Vol. VI, No. S, pp. 329-368. 

94 



I sudor H. Coriat 95 

may be observed in organisms which have not been sub- 
jected to stimuli that would lead to fatigue. Lower organ- 
isms, however, are very sensitive to light, but whether this 
influence to light is a chemical or a mechanical phenomenon 
cannot be discussed at present. For instance, many motile 
forms collect in regions of a given light intensity, some orient 
themselves towards the source of light and others away from 
it, into shadows or where the light is diminished.* These 
light reactions may be decidedly rhythmic in character and 
because they usually result from sudden changes in the 
intensity of light, they seem compulsory and mechanical. 
It has been found, for instance, that a sudden increase in the 
intensity of light will cause restlessness in earth worms and 
fresh water planarians. Diminution of the intensity of 
light inhibits these restless reactions and causes the creature 
to come to rest, or if such a creature goes from a light area 
to a dark one its activity becomes reduced to a minimum, 
it becomes motionless and seems to fall asleep. 

It seems probable that out of these periods of immobility 
and rest sleep arose. Light is a distance receptor and the 
activity of these organisms ceased when these particular 
receptors failed to throw its nerve elements into activity. 
The same mechanism probably takes place in the sleep of 
man and the higher animals from the inhibition of distance 
receptors. If sleep is an instinct, it was not so in the primi- 
tive organisms, but in these creatures, it was a tropism, a 
mechanical or chemical necessity for repose under condi- 
tions where light was absent. From this tropism-like re- 
action, sleep arose, a veritable impulse of living matter to 
higher and higher rhythmic activities, motility on the one hand, 
with its freedom of action and the consequent development 
of the nervous system, periodic immobility on the other, 
in the effort to protect this nervous system from the per- 
nicious effects of over-activity. Thus those organisms 
which showed these rhythmic reactions of immobility and 



*0n the various tropisms and the reactions of organisms to light, and the 
interpretation of these phenomena from the standpoint of comparative psychol- 
ogy, see the publications of Loeb, Pieron, Bohn, Jennings, Verworn, Claparede, 
and Mast. 



96 The Evolution of Sleep and Hypnosis 

repair were those which survived in the biological struggle 
for existence. 

Let us investigate these complex reactions to light more 
closely. Sometimes instead of attaining a definite axial 
position or orientation to the source of stimulation, the 
organism as a whole will move from light to shadow or 
vice versa. Whether or not these reactions are adaptive 
or mere mechanical automatisms is one of the most im- 
portant questions of comparative psychology. Probably 
the phenomenon, at least in the more primitive organisms, is 
not psychic, the light in these cases acting as a mere direc- 
tive stimulus. We are dealing here with a process vari- 
ously termed heliotropism or phototaxis. The fact that in 
brainless planarians can be demonstrated the same sensi- 
tiveness to light, but that the reaction time to arrive at 
immobility is longer, speaks in favor of the mechanistic 
hypothesis. 

Histological investigations on planaria and earth worms 
seem to indicate that the photo-sensitive elements are dis- 
tributed over the body surface. That the reaction to light 
is a mechanical or a chemical response without the involve- 
ment of consciousness or perception, a mere mechanism, is 
demonstrated by two facts; first, that brainless organisms 
show the same reaction, and secondly, blinded organisms be- 
come motionless when the light intensity is suddenly reduced, 
or what amounts to the same thing, when shadows are sud- 
denly thrown over the bodies of the creatures. These re- 
actions to shadows seem to be defense reactions, because a 
shadow would naturally herald the approach of an enemy. 
Then the organism becomes motionless, a condition under 
which it would be less likely to be perceived. Analogous 
conditions are sometimes found in the higher animals, 
namely, simulation of death, but here the defense reaction 
is intellectual and not mechanistic. Thus these latter 
reactions are in a general way adaptive and serve a purpose 
in not only protecting the creature from external influences, 
but likewise have a reparative action. 

Sleep, therefore, in these lower organisms seems a mere 
rest state, a negative heliotropic reaction, because of the 
poverty of the creature in receptor organs. As the animal 



Isador H. Coriat 97 

evolved, as the spinal cord became a complicated reflex 
mechanism and the brain the dominant organ of conscious- 
ness, the various receptors became more numerous and 
complicated, and parallel with this there arose rhythmic 
states of activity alternating with rest or sleep. 

It is well known that we cannot get along without sleep 
and yet the important question arises — why is sleep bio- 
logically necessary? Genuine sleep only exists in organisms 
with a developed nervous system, and it has been shown 
that the motionless states in lowly organisms, when in 
shadows or in darkness, is not sleep. Sleep also seems to be 
due to a cessation of activity of the receptor organs and this 
in turn causes a diminished activity of the central nervous 
system. In sleep, the brain and spinal cord alone seem to 
be the seats of diminished activity, for the body metabolism 
during sleep does not differ much from that of the waking 
state. Sleep is an organic need, in the same way that hunger 
is an organic need. The effect of complete sleeplessness, 
as shown by experimental evidence, is to cause severe changes 
in the nerve cells. Therefore, the activity of the nerve cells 
furnishes the key to sleep. The Nissl bodies of the nerve 
cell accumulate during repose and disappear in activity, 
particularly under conditions of fatigue. In the brains of 
chickens and dogs which have been suddenly killed during 
sleep, there has been found an increase of the Nissl bodies. 
This substance, therefore, accumulates in the nerve 'cells 
during their functional inactivity, when the sensory stimuli 
pouring into these cells from without are greatly diminished. 
Normal nerve cells, or nerve cells in a state of rest, show these 
Nissl bodies with great clearness. It is only in the fatigued 
cell or the cell which has been poisoned by toxic substances 
or through the influence of increased temperature in fever, 
that these bodies are disintegrated and in many cases com- 
pletely disappear, giving the cell a washed-out appearance 
(chromatolysis). Therefore, sleep is a mechanism for the 
repair of nerve elements which have become disintegrated 
from the bombardment of stimuli received by the various 
surface receptors and receptor organs of the special senses. 
Those organisms, which by reason of rest and immobility 
when they went into darkness or shadows, showed the 



98 The Evolution of Sleep and Hypnosis 

greatest repair, were the very organisms which survived in 
the evolutionary struggle and sleep evolved out of these 
motionless states. This reparative power is absolute, for, 
no matter how great the fatigue or long the insomnia, only a 
few hours of complete sleep is necessary, as demonstrated 
by some exact experiments on the loss of sleep in man. 

Much of the same principle may be applied to the evolu- 
tion of hypnosis. Many animals seem to furnish examples 
of spontaneous hypnotic states, for instance, the simulation 
of death, or still better, the fascination of birds by snakes, 
which seems to be a kind of hypnosis with catelepsy. Many 
animals show motionless states in reaction to fear. While 
motionless states of the nature of genuine hypnosis or cere- 
bral inhibition may be produced artiiically in certain ani- 
mals (birds, frogs, guinea pigs, cray fish), yet probably in the 
phylogenetic scale, such states were made possible of arti- 
ficial production because spontaneously the normal defense 
reactions of these animals showed similar phenomena. If 
we assume that these motionless states arose in animals out 
of stationary reactions while waiting for their prey or for 
purposes of defense, we must also assume that this was an 
intelligent experiment on the part of the animal. Thus 
hypnosis had probably a biological origin like sleep, but 
since the former was unnecessary for the preservation of the 
species, it became only incompletely developed spontaneously 
and could only be artificially produced. Even then, it did 
not appear until the animal began to show intelligent re- 
actions, a defense or instinctive action on one hand and a 
hunger reaction on the other. These reactions, however, 
while of great value, did not have the biological importance 
of sleep, namely, a repair of nervous tissue, and therefore 
they did not become like sleep, automatic and spontaneous. 



THE TREATMENT OF WRITER'S CRAMP AND 
OTHER OCCUPATIONAL NEUROSES 

TOM A. WILLIAMS, M.B.C.M., EDIN. 

Corresponding Member Paris Neurological Soc, Psycho- 
logical Soc, etc., Neurologist to Epiphany Dispensary, 
Washington, D. C. 

The Treatment of Writer's Cramp 

TO a clear-minded person who realizes that the "grip 
is being lost," as the telegraphers call it, the 
psychogenesis of occupational cramp is apparent. 
The resulting treatment is illustrated in the fol- 
lowing cases: 

AUTOTHERAPEUSIS OF AN OCCUPATIONAL NeUROSIS 

An exceedingly efficient sender for a metropolitan 
newspaper one day found that he was failing to send properly 
the five short taps which in the Morse code represent the 
letter P. Knowing the risk of telegrapher's paralysis, he 
at once set to work to conquer the sending of the letter P, 
and spent his intervals between sending and receiving 
messages in practising that letter, until at the end of two 
or three days, he found he could accomplish it as well as 
before. 

The second case is that of a physician who is now 
himself much interested in psychopathology; the account* 
is written by himself. 

Temporary Writer's Crai^p in a Physician, Auto- 

THERAPEUTICALLY ArRESTED 

"Having occasion to stop in a newspaper office one 
morning when a case of great medico-legal interest was 
occupying public attention, the editor asked me for a state- 
ment of my opinion for publication. He showed me the state- 
ment of two medical men of prominence who had also been 
interviewed. As I was under some obligation to the editors, 
I consented. He asked me to hurry, as they were about to 
go to press, and handing me pencil and paper, told rhe to 

99 



100 The Treatment of Writer^ s Cramp 

sit down at his desk. He sat to one side and watched me as 
I wrote. The situation was a strange one, and the hurry 
and confusion of the office extremely distracting. I was 
obliged to think rapidly and to place my thoughts upon 
paper as quickly as possible. I wished my interview to 
compare favorably with the others. I was conscious that 
within an hour what I had to say would be read by thou- 
sands. As I substantially agreed with the statements of 
the other physicians who had been interviewed, I felt the 
need of saying the same thing in language sufficiently 
different to cause my statement to seem somewhat original. 
As I wrote, I became more and more dissatisfied with what 
I had to say. The point of the pencil broke twice, causing 
me much annoyance. My hand suffered a distinct cramp 
by the time I had finished the second page. I had begun 
my statement in a large, plain hand. Soon I saw that my 
writing was growing very illegible; and I thought the com- 
positor would not be able to read it. All this caused me to 
be still more annoyed with myself. The hand was now 
painfully cramped, and I had difficulty in holding the pencil, 
and was obliged to write with an arm movement, which is 
not my habit. When I finished, the cramp lessened, but 
was followed by a distinct and complete paralysis, which 
lasted for about an hour. Later in the day, on attempting to 
use- a pen or pencil, the cramp returned. The next morning 
the difficulty had disappeared. 

"The paralysis was for all the finer movements of the 
hand. I remember that I was obliged to button my over- 
coat with the left hand. 

"Fatigue was not a factor. My statement was brief, 
not more than four or five p^es. 

"The psychic factors were, as near as I can tell, funda- 
mentally distraction and anxiety, although at the time I 
doubt if I were very conscious of either.''^ 

The Difficulties 

Very different is the result when a cramp arises in a 
person of credulous disposition, who is unfortunate enough 
to be advised by a physician lacking in psychological good 
sense and imbued with the confused ideas regarding the 



Tom A. Williams 101 

genesis of spasms, tics and other myoclonias which are all 
that can be found at present in the English text-books. 

Such a physician only reinforces the patient's belief 
that his disability resides in some modification of bodily 
structure. This collusion of misinterpretation eventuates 
in the all too common course of massage, electricity, tonics, 
nerve excitants, or rest and calmatives, according to the 
theoretical predilections of the physicians. In spite of the 
suggestive effect of these measures in breeding self-confi- 
dence and hope, failure is the rule,- and the patient may then 
have recourse to various charlatans. These, however, are 
no better informed of the pathology of occupational cramps 
than were the physicians who failed, and the patient gives 
up, believing himself incurable. 

Hence, the first task of the therapeutist is often to 
convince the patient of the pathogenesis of his affection in 
order that he may be persuaded to undertake a treatment 
which will be neither short nor easy. 

The keynote to this treatment is that the patient clearly 
understand the mechanism of his affection. Upon the basis 
of this understanding, physician and patient then develop 
precedures for the re-education of the perverted psycho- 
motor succession which determines the abnormal movements. 
Before expounding the principles of this, the difficulties 
should be foreseen and explained to the patient. The first 
of these is the practical one of .the length of the treatment, 
which is of course a serious inroad upon the time of both 
doctor and patient, and considerable expense to the latter. 

The second difficulty is that the re-education consumes 
much energy; and a patient who is already working hard 
for his living may not be able to spare this, any more than 
can a physician with multiple duties. But if these difficul- 
ties are transcended, there remains the psychological one 
of the patient's willingness to undergo a discipline which 
may go to the extent of changing his mental habitus. Thus, 
a hyper-suggestible, impulsive individual will require a great 
effort to accommodate himself to the careful slowness of 
control needed in the mastery of a disorderly movement. 
On the other hand, a person of timid, hyperconscientious 
disposition, who takes the most trivial detail with an in- 



102 The Treatment of Writer'' s Cramp 

tensity demanding his whole powers, may not be wilHng 
to undertake the long course of training required to unlimber 
mental processes bound into a scrupulousness which inter- 
feres with the acquisition of a spontaneous automatism re- 
quired in the practice of any art. 

The Psychomotor Discipline — Its Technique 

These difficulties having been faced, and treatment 
resolved upon, a psychomotor discipline is instituted. It 
begins with the movements of the larger joints, which are 
phylogenetically better established, and within their limits 
easier to control. 

The end aimed at is largeness and smoothness of move- 
ment; all sudden jerking must be avoided; and the binding 
of muscles must be unlimbered. Gentle swinging movements, 
followed by Indian club exercises are a convenient intro- 
duction. Success is usually rapid, and then the second stage 
can be begun. This consists of directing the same principles 
to the use of the joints around which the cramp has occurred. 
Slow, smooth movements in different directions are at first 
practised, and at least until complete control is attained. 
Then some tool or instrument is grasped in the hand and 
wide sweeping movements made with this. Until this can 
be done with complete freedom, no use of the tool should 
be permitted; but when cramping ceases to occur the 
patient is directed to use his pencil or other instrument in a 
professional act. When this is begun, there is a great 
tendency for the patient's mind to concentrate upon the 
product of his act, viz., the writing or other work, and to 
wander from the act itself. This is the great difficulty at 
this stage of the treatment. To avoid it, the patient must be 
induced not to think of the form he is drawing, but to con- 
centrate upon the movements he is making. 

To prevent cramping, all movements must at first 
be large, wide and sweeping. The lines made will therefore 
be round, and the forms large. The motion should be per- 
fectly smooth, and not too slow, or binding is apt to occur. 
If it is made too rapidly, on the other hand, the muscles 
will contract too suddenly, and tend to jerk into cramp. 



Tom A. Williams 103 

The preliminary flourishes of an ornate writer furnish a 
good model of the speed and style of movement to be aimed 
at. 

Finally, the patient should not practise long at a time, 
or there will be a flagging of the attention needed to co- 
ordinate a vast number of muscular contraction and relax- 
ations; and when attention relaxes, the old habit, which is 
that of the cramp, regains ascendancy and vitiates that 
attempt and makes the ensuing one still more difficult. 

But the sittings should be frequent, so that practice 
may be abundant; and each acquisition should be established 
before, there is time for it to be forgotten. 

When large writing can be performed automatically 
without tendency to cramp, a gradual reduction of ampli- 
tude of movemeilt is attempted; and when a reasonable 
size of writing is attained, the patient may be gradually 
permitted to resume writing in which the end is not the 
manner but the matter. The cure is then only a matter of 
continued attention and further practice. Relapses, which 
are frequent, are due to the relaxation of earnest attention 
by the patient, and it is sometimes a hard task for the 
physician to prevent the natural tendency to a relapse into 
easy-going automatism before perfect freedom of movement 
has been attained. 

A full account of several cases upon which this treat- 
ment has been based is given in a current number of 
Brodwell's Jour. d. Neurologic u. Psychiatrie (Leipsig). 



POETRY AND DREAMS 

{Concluded) 

BY F. C. PRESCOTT 

Cornell University 
III 

Let us now again return to the subject of dreams. 
Dreams, as has been said, have their origin in the depths of 
the mind, in unconscious mental processes, — that is, in proc- 
esses which do not come to our knowledge except indirectly, 
or under unusual or abnormal conditions, — the conditions 
supplied, for example, in dreams, in day dreams and halluci- 
nations, and in certain neurotic activities. Under ordinary 
conditions there is a force operating to prevent these proc- 
esses from rising to the surface of consciousness. If the 
reader has ever tried to recall any matter — for example, 
a proper name — which has fallen out of his recollection, 
and which he can almost but not quite recollect; if he has 
felt himself, so to speak, struggling to recover this matter 
and baffled in his efforts, he can form some idea of the re- 
pressive force in question.^ This force is called in the dream 
theory the "psychic censor"; it "stands at the gateway of 
consciousness." In general, it prevents the deeper processes 
from becoming conscious. Under certain conditions, how- 
ever, when this force is relaxed, as in sleep, it allows the re- 
pressed material to pass, or permits an evasion. That is, 
it permits such material to pass, but only in a disguised and 
distorted form, under which it escapes recognition. The 
so-called psychic censor, as its name implies, resembles a 
public censorial officer, say of the political press, who will 
not allow unpleasant truth to pass for publication, but may 
be evaded by a veiled or disguised representation. In 
dreams the latent content is under repression; it passes the 

^ Freud explains this amnesia as caused by a connection between such a name 
and material which is under repression. See Psychopathologie des AUtagslebens, 
p. 3. 

104 



F. C. Prescott 105 

censor only in a disguised and distorted form, in which it 
becomes unrecognizable — that is, in the form of the manifest 
content. 

The operations by which, under the direction of the cen- 
sor, the underlying thoughts are transformed into the appar- 
ent dream are called the "dream work" {Traumarbeit)} 
They cannot be fully explained here, this being the most 
complex and difficult part of the dream theory. Through 
these operations, however — described technically as "con- 
densation," "displacement," "secondary elaboration," etc. — 
the underlying thought is in appearance completely trans- 
formed; it is bodied forth in a strange guise which bears 
little or no resemblance to the original. This explains why 
dreams appear absurd and imcomprehensible; only when 
these disguises have been stripped off, only when the work 
of the censor has been retraced and undone, do they disclose 
their underlying thought. An interpretation of dreams, 
then, requires a knowledge of the dream work. 

In this transformation, however, one element remains 
unchanged. A dream is always emotional, and the emotion 
which has properly belonged to the original dream-thoughts 
still clings to the final dream, where sometimes it seems 
strangely out of place. That is, intense feeling is sometimes 
attached to apparently most trivial things, the explanation 
for this being that feeling is transferred to these things 
from the more important ones in the original for which they 
stand. Whatever strange forms the dream may take this 
emotion is real and vital; "im Traume ist der Affect das 
einzig Wahre." 

Some features of this transformation, effected by the 
dream work, require for our purposes further explanation. 
The dream is fictional in two senses. In the first place it 
represents an ungratified desire as gratified, substituting 
for the utinam of the latent content a phantasm of gratifica- 
tion. In the second place it represents the abstract by a 
symbolical concrete. The underlying material, the ele- 
ments from which the dream is formed, with the desires 
as motive power, may be anything which finds place in the 
human mind — persons and places, thoughts and opinions, 

^Die Traumdeutung, VI. 



106 Poetry and Dreams 

facts observed or inferences from facts, concretions or ab- 
stractions. In the dream these elements are reduced or 
transposed into one simple form. The dream, as a rule, 
represents not thoughts but actions. In a dream we take 
part in an action as one of the actors, or see a situation 
before our eyes. A dream is a kind of dramatic represen- 
tation, a series of scenes in that theatre of the brain which 
Stevenson describes; and only such elements as are capable 
of being put upon the scene can pass into the dream. A 
thought cannot be directly" represented; it must be enacted, 
and therefore the dream makes constant use of symbols. 
The symbolism of the wildest poet falls short of the sym- 
bolism constantly employed in dreams. Temporal relations 
cannot be represented; in a dream the time is always present. 
Logical relations cannot be represented; the dream cannot 
deal directly with an if or a because. Such temporal or 
logical relations must be expressed, if at all, somehow in- 
directly in accordance with the dramatic principle. Thus 
a dream is mainly visual in nature. It may include sounds 
and other sensations. It is, however, properly a vision. 
All underlying elements must either be suitable ingredients 
of a vision or be transformed into such ingredients, — made 
visible, or at least sensible. The dreamer, then, sees a 
vision representing symbolically the gratification of his wish. 
Dreams often take us back to the experiences of early 
childhood. The reader has, perhaps, like the writer, found 
this one interesting feature of his dreams, — that they some- 
times bring up long-forgotten incidents, faces, emotions, 
with surprising vividness. In dreams, as Dryden says, 

"Sometimes forgotten things long cast behind 
Rush forward in the brain and come to mind. 
The nurse's legends are for truth received. 
And the man dreams but what the boy believed." ^ 

Day dreams also often take us back to childhood. Drown- 
ing persons are said to see their whole lives, including events 
in early life long lost from conscious remembrance, in the 
twinkling of an eye; perhaps this vision is somehow related — 

iThe Cock and the Fox, 11. 333-336. 



F. C. Prescott 107 

the projection of an instinctive, sudden, strong desire to live. 
Such early memories appear recognizably in the manifest 
content of dreams; according to Dr. Freud they appear even 
more frequently in the latent content. Indeed, the latent 
content of every dream probably goes back for some of its 
elements, for a part at least of the desires which actuate it, 
to the experiences of childhood. These experiences have 
perhaps been entirely forgotten; the early desires have been 
for some reason repressed. They reappear, however, in 
dreams, in which we live back into childhood again. "Das 
Traumen," says Dr. Freud, "ist ein Stuck des iiberwun- 
denen Kinderseelenlebens."^ The dream usually seizes upon 
some trivial incident of the preceding day — trivial because 
such incidents will be free of associations — and makes this a 
starting-point or point of crystallization, to which the old 
experiences may attach themselves. But the old experi- 
ences are the important elements. The significance of these 
facts for our purpose we shall see presently when we return 
to poetry. Just as the dream materials are largely derived 
from childhood, so in dreams we act and feel as children; 
we escape into an irresponsible world of play which has 
its only counterpart in childhood. In recounting our 
dreams we laugh at our strange actions in them, as we 
should laugh at the actions of children. In general 
the dream experiences, as compared with those of 
waking, have a kind of freshness and vigorous youth- 
fulness about them as if they stood nearer to life's 
source. 

The mental activity which produces dreams is different 
from that of ordinary waking life. It is apparently more 
simple, elementary, or central — perhaps we may say more 
childlike. A faculty is at work, which is active also in 
waking, but here works in a different way or under different 
control. This is an image-making faculty or imagination, — 
the phantasy ( -vTaaia ) to which Aristotle attributes 
dreams, hallucinations, and illusions. This faculty is sit- 
uated between the senses on the one hand and the intellect 
on the other, reproducing images derived through the senses, 
combining these under the direction of the intellect, and fur- 

1 Die Traumdeutung, p. 349. 



108 • Poetry and Dreams 

nishing material for thought/ Thus in waking moments it 
is under the control of the intellect. But when the mind is 
relaxed — at rest or asleep — when it is not on the one 
hand taking in new sensations or on the other engaged in 
thought, this faculty, continuing active, answers other 
more recondite purposes. It subjects itself to the hidden 
desires of the mind and produces pictures at the instance of 
these desires. It is, so to speak, no longer at work, but at 
play. As Dryden says: 

"Dreams are but interludes which fancy makes; 
When monarch reason sleeps this mimic wakes. "^ 

The pictures which this faculty produces when it escapes 
from the control of the intellect, as in dreams, we call /<^n^(^j-^zV. 

We may now return to poetry. We have seen that the 
motive impulse in poetry is supplied by the poet's desires. 
There are repressive forces, corresponding to the censor of 
the dream theory, which conflict with and control the poetic 
impulse. These forces have already been mentioned; they 
are the impediments to expression of Keble's theory. The 
selfish individual impulse cannot give itself free expression; 
it must have regard for appearances, for convention, for 
morality. This matter will be considered more fully later. 
In general the conflict is between the native inspiration of 
the poet and external authority of whatever kind; the prin- 
ciple of control arises from the latter. 

This may be illustrated most readily in the form of 
poetry, its rhythm and metre, which gives utterance to both 
elements — the impulse and the control — or is also, like the 
subject matter, produced by their conflict. Strong and un- 
restrained emotion expresses itself in waves, with a throb- 
bing or pulsation, in recurrent movements appearing in 
voice and gesture, which constitute a natural rhythm. 
Poetry, an emotional expression, has this rhythm. The 
beat of a passage of poetry or impassioned prose is not a 
superadded ornament, but an inevitable and vital accom- 
paniment of such expression, going back, we may imagine, 

1 E. Wallace, Aristotle's Psychology, p. Ixxxvii. 

2 The Cock and the Fox, 11,325-326. 



F. C. Prescott 109 

for its origin to the poet's heart. It is, as Shelley says, 
an "echo of the eternal music." In a free expression this 
rhythm would be bound by no law but that imposed by the 
feeling itself. In certain poets of a primitive or strongly 
individual kind, for instance in Ossian or Walt Whitman, 
it is felt in something like its native wildness and force. 
Usually, however, it is restrained by regard for the tradi- 
tions and conventions of the poetic style. In Tennyson, for 
example, it has become conventionalized — subjected to 
prosodial law. The rhythm has become measured, metri- 
cal; it has been adapted to recognized forms of line and 
stanza. 

The nature and cause of this metrical restraint are well 
stated by Keble. "The conventional rules of metre and 
rhythm . . . may be no less useful, in throwing a kind of 
veil over those strong and deep emotions, which need relief, 
but cannot endure publicity. The very circumstance of their 
being expressed in verse draws off attention from the vio- 
lence of the feelings themselves, and enables people to say 
things which they could not express in prose, much in the 
same way as the musical accompaniment gives meaning to 
the gestures of the dance, and hinders them from appearing 
to the bystanders merely fantastic. This effect of metre 
seems quite obvious as far as regards the sympathies of others. 
Emotions which in their unrestrained expression would ap- 
pear too keen and outrageous to kindle fellow feeling in 
any one are mitigated and become comparatively tolerable, 
not to say interesting to us, when we find them so far under 
control as to leave those who feel them at liberty to pay 
attention to measure and rhyme, and the other expedients 
of metrical composition. But over and above the effect 
on others, we apprehend that even in a writer's own mind 
there commonly exists a sort of instinctive delicacy, which 
finds its account in the work of arranging lines and syllables, 
and is content to utter, by their aid, what it would have 
shrunk from setting down in the language of conversation; 
the metrical form thus furnishing, at the same time, a vent 
for eager feelings, and a veil of reserve to draw over them."^ 

i^ritish Critic, Vol. XXIV, p. 435. Cf. Coleridge, Biographia Literaria, 
Chap. XVIII, on the origin of metre. 



110 Poetry and Dreams 

The form of poetry, then, is the product of two forces — 
the rhythmic impulse, and the control represented by metre, 
line, stanza, and the like.^ The natural rhythm of unre- 
strained emotion would be unpleasing to a hearer as wanting 
in regard for this hearer — as wanting art; it must accord- 
ingly be reduced to recognized forms. It must not, how- 
ever, be lost in this reduction, but must be felt constantly 
behind and through these forms giving them animation. 
In a poet like Shelley, in whom the poetic impulse is strong, 
the natural rhythm is always so felt; it even constantly 
threatens to break through the bonds of form and secure 
its freedom. In Pope, in whom the poetic impulse is weak, 
or at any rate in some of the followers of Pope, in whom 
native impulse is wanting, the form is everything, and the 
echo of the eternal music is entirely lost. The old question, 
whether or not metre is essential to poetry, must be an- 
swered formally, as the best critics from Aristotle to Words- 
worth have answered it, in the negative; in every tolerable 
literary expression, however, — even in that other harmony 
of poetical prose, which has not only its rhythm but its 
laws no less exacting than those of verse — there must be, 
or will be, not only the element of inspiration but the ele- 
ment of control, which in poetry employs metre as one of its 
commonest instruments. Art as well as inspiration is 
essential to poetry. 

The principle thus illustrated in the form of poetry 
may be applied also to its substance. The significant figure 
of the veil which Keble twice applies to the form, he em- 
ploys again in describing the substance, in which the same 
controlling forces are at work. "In the prose romances of 
Sir Walter Scott," he says, "and in all others which would 
be justly considered poetical, it will be found, we believe, 
that the story is, in fact, interposed as a kind of transparent 
veil between the listener and the narrator's real drift 
and feelings." Scott's ruling passion, his desire to live 

i Rhyme has the effect of dividing the expression into lines of regular length 
recognizable by the ear. Intrinsically, however, it goes back probably to a primi- 
tive or childish fondness for playing and jingling with the sound of words without 
regard to their meaning. For this impulse in children, see Freud, Der Witz und 
seine Beziehung zum Unbewussten, p. 105. 



F. C. Prescott 111 

in the past and to make the past live again, met, as Keble 
shows, various checks; it could, however, be freely expressed 
in the guise of a story. This case is typical; every creative 
poetical work is such a veiled representation. The deep 
feeling of the poet cannot have a direct but only an indirect, 
or, so to speak, censored expression, through the medium of 
what Keble calls "associations more or less accidental." 
The poet's product, like the dream, is a fiction in two senses. 
In the first place, it is a phantasy representing an actually 
ungratified desire as gratified. In the second place, this 
representation is not direct but indirect or veiled; it is 
allegorical, figurative, or symbolic. It lets one thing stand 
for another and by this means bodies forth, in concrete 
sensible forms, the hidden motions of the soul of the poet. 
Or, as Shelley beautifully expresses the same thought, 
"it arrests the vanishing apparitions which haunt the in- 
terlunations of life, and veiling them, or in language or in 
form, sends them forth among mankind bearing sweet news 
of kindred joy to those with whom their sisters abide — 
abide, because there is no portal of expression from the 
cavern of the spirit which they inhabit into the universe 
of things."^ 

The characteristic operation of the poet's mind, then, 
consists in an embodying of his deep feelings, his uncon- 
scious desires, in the fictional forms which we recognize as 
customary in and proper to poetry. This operation, how- 
ever, or the modes in which this embodiment is effected, 
are untraced and obscure. The final product of the poetic 
imagination, the manifest poetry, is a complex construction, 
or, to employ a probably better word, a complex vital growth, 
out of the depths of the poetic mind. We can only surmise, 
for example, by what strange organic action the religious 
emotion of John Bunyan gathered to its use the sensations, 
experiences, thoughts, available associations of whatever 
kind, contained in the dreamer's mind, and thus grew into 
the series of scenes which make up Pilgrim's Progress. In 
order to trace this complex operation we should have to know, 
more fully than we can ever knowit,the history of this poet — 

^Defense of Poetry, ed. Cook, p. 41. 



112 Poetry and Dreams 

his early training, his experiences, the people he met, the 
books he read, the sermons he heard — the whole growth 
and content of his mind. If we had all these facts as data, 
and if we knew the working of the poetic faculty, then we 
might trace the growth of his poetic product from its original 
moving emotion to its final form. We have not the data 
and we do not know the working of the poetic faculty. 
There is, we may conjecture, trusting to the parallel we have 
been following, a "poetic work" — Dichterarbeit — -corre- 
sponding to the dream work already referred to. If we were 
familiar with the mechanisms of the former, as according 
to Dr. Freud we now are with the latter, then doubtless 
— given the necessary biographical data — we might analyze 
poetry, like dreams, to discover its underlying motives and 
sources. Perhaps a study of Dr. Freud's mechanisms of 
condensation, displacement, etc., might throw much light 
on the working of the poetic faculty. Perhaps, for example, 
the extraordinary concision and significance of poetry, as 
compared with prose, is not due to mere brevity or- ellipsis, 
but partly to "condensation," in the sense in which this 
term is used in the dream theory — that is, to the fact that 
each portion of the poetic product is "over-determined," 
and has many roots in the poet's mind.^ We cannot fully 
explore the field thus indicated at this point. 

Some observations, however, may be made. Poetry, 
like the dream, is always a product of emotion. "No 
literary expression," says Theodore Watts, in his admirable 
essay on the subject, "can, properly speaking, be called poetry 
that is not in a certain deep sense emotional."^ And just 
as in the transformation of the dream the original feeling of 
the dreamer passes through without change of quality and 
attaches itself to the manifest dream, so probably in the 
transformation of poetry the original feeling of the poet 
retains its original tone if not its original intensity; though 
all else may be fiction, this remains real; the final poem, 
whatever fictitious expression it may employ, is transfused 
with the true feeling of the poet's heart. Thus the genuine 
feature of poetry lies in its feeling; this may attach itself to 

^For condensation, see Die Traumdeutung, p. 204. 
^Encyclopedia Britannica, "Poetry." 



F. C. Prescott 113 

the wildest fiction; but the fiction still appeals to us as es- 
sentially truthful because it is animated by truth. 

Poetry again, like the dream, is concrete in its method; 
and the ingredients of poetry like the ingredients of the dream 
must conform to this principle of composition. Poetry 
is correctly defined by David Masson as "the art of produc- 
ing a fictitious concrete."^ "With abstractions," to quote 
again from Theodore Watts, "the poet has nothing to do, 
save to take them and turn them into concretions." The 
poet may think as well as feel; he may start with abstract 
truths, but his thoughts and his truths are only the under- 
lying elements of his poetry. The thoughts cannot be ex- 
pressed directly; they must be reduced to concrete terms, 
appropriately embodied in the actions of things and persons, 
expressed in the proper poetic language of figures and sym- 
bols. So one evidence of Goethe's poetic mastery, accord- 
ing to Carlyle, was his "singularly emblematic intellect; 
his perpetual never-failing tendency to transform into 
shape, into life, the opinion, the feeling that may dwell 
within him, which, in its widest sense, we reckon to be 
essentially the grand problem of the poet. . . . Everything 
has form, everything has visual existence; the poet's 
imagination bodies forth the forms of things unseen, his pen 
turns them to shape. "^ But we may as well quote directly 
from Shakespeare: 

"And as the imagination bodies forth 
The forms of things unknown, the poet's pen 
Turns them to shapes, and gives to airy nothing 
■ A local habitation and a name. 
Such tricks hath strong imagination: 
That, if it would but apprehend some joy 
It comprehends some bringer of that joy."^ 



Wordsworth, Shelley, Keats, and Other Essays, p. 201. Criticism, according 
to Mr. W. C. Brownell, is the reverse of poetry: "Criticism, then, may not 
inexactly be described as the statement of the concrete in terms of the abstract." 
Atlantic Monthly, April, 1911, p. 548. This illuminates the relation between poetry 
and criticism and the value of the latter. 

^Essays, "Goethe." 

^Midsummer Night's Dream, Act V, Sc. 1. 



114 Poetry and Dreams 

So, according to Aristotle's theory, "A work of art re- 
produces its original, not as it is in itself, but as it appears 
to the senses. It addresses itself not to the abstract reason 
but to the sensibility; ... it is concerned with outward 
appearances; it employs illusions; its world is not that which 
is revealed by pure thought; it sees truth, but in its concrete 
manifestations, not as an abstract idea."^ 

Poetry, then, like dreams, is concrete; its representation 
is made "under forms manifest to sense"; perhaps, also, 
chiefly and characteristically under forms manifest to the 
sense of sight. The words commonly employed in describ- 
ing the poet's activity suggest this mainly visual character. 
He portrays and pictures; he imagines; "imaging," Dryden 
declares, "is in itself the very height and life of poetry."^ 
To the poet, as to the dreamer, is ascribed the power of 
vision. 

In dreams we have seen that some incident of the pre- 
ceding day, which is free of associations, serves as a start- 
ing-point or point of crystallization. So the inspired poet 
often finds in some casual experience — a mountain daisy or 
a bright star or a region about Tintern — a centre around 
which his poetical conceptions may gather. Of his famous 
poem Wordsworth says, for example, "I began it upon leav- 
ing Tintern, after crossing the Wye, and concluded it just 
as I was entering Bristol in the evening. . . . Not a line of it 
was altered, and not any part of it written down till I reached 
Bristol." Of this feature of the poetic work, however, the 
best account is given by Goethe. In Dichtung und Wahr- 
heit, he says that after trying suicide and giving it up he 
determined to live. "To do this with cheerfulness, however, 
I required to have some poetical task given me, wherein all 
that I had felt, thought, or dreamed on this weighty busi- 
ness might be spoken forth. With such view, I endeavored 
to collect the elements which for a year or two had been 
floating about in me; I represented to myself the circumstances 
which had most oppressed and afflicted me: but nothing 
of all this would take form; there was wanting an incident, 
a fable, in which I might embody it. All at once I hear 

^Butcher, Aristotle's Theory of Poetry, pp. 127, 153. 

^The Author's Apology for Heroic Poetry and Poetic License. 



F. C. Prescott 115 

tidings of Jerusalem's death, ... in this instant the plan 
of Werther was invented: the whole shot together from all 
sides, and became a solid mass; as the water in a vessel, 
which already stood on the point of freezing, is by the 
slightest motion changed at once into firm ice."^ 

We may suppose, however, from the analogy of the 
dream that this casual experience contributes only the final 
touch; and that the essential elements of poetry go back 
to deeper experience and more settled emotions. It would 
be difficult to show by direct evidence that poetry generally 
or often goes back to repressed experiences of childhood. 
Other considerations, however, suggest that in some respects 
the parallel holds again here. Poetry has the same freshness 
and youthfulness we have noted in dreams; it also has upon 
it the dew of morning and the light of the east. The poet's 
mind works in a primitive and, without disparagement, 
childlike way. The poet has the "wild wit, invention ever 
new," which Gray attributes to childhood.^ The poet, like 
Walt Whitman, is "a man, yet by these tears a little boy 
again. "^ "The moment the poetic mood is upon him all 
the trappings of the world with which for years he may have 
been clothing his soul — the world's knowingness, its cyni- 
cism, its self-seeking, its ambition — fall away, and the man 
becomes an inspired child again, with ears attuned to nothing 
but the whispers of those spirits of the Golden Age, who, 
according to Hesiod, haunt and bless this degenerate earth.'"* 

Indeed the Golden Age, with its clear bright figures, 
and the Garden of Eden, with its first mortal pair, who were 
naked yet unashamed, and who had not yet eaten of the tree 
of the knowledge of good and evil, are in some sense doubt- 
less only beautiful dreams, poetic visions, going back either 
to the childhood of those who first conceived them or more 
broadly to the childhood of the race. In these myths is 
seen most clearly the connection between dreams and poetry 
which we have been trying to trace. They are the dreams of 

^Carlyle's translation; Essays, "Goethe." 
^"Eton College." 

^"Out of the Cradle Endlessly Rocking." The whole poem is an excellent 
commentary on our text. 

^T. Watts, Encyclopedia Britannica, "Poetry." 



116 Poetry and Dreams 

nations, bearing somewhat the same relation, as Dr. Abra- 
ham has shown,^ to the dreams of the individual which folk 
poetry bears to the poetry of the individual poet. They are 
likewise the beginnings of our poetry, and furnish a clear 
explanation of the working of . poetic genius. "The theory 
which has been applied to the Grecian mythology," says 
David Masson, "applies equally to the poetic genius in 
general. The essence of the mythical process, it is said, lay 
in this, that the earlier children of the earth having no 
abstract language, every thought of theirs, of whatever 
kind, and about whatever matter, was necessarily a new act 
of imagination, a new excursion into the ideal concrete. 
If they thought of the wind, they did not think of a fluid 
rushing about, but of a deity blowing from a cave; if they 
thought of virtue rewarded, they saw the idea in the shape 
of a visible transaction in some lone place, between beings 
human and divine." It is this primitive poetical faculty for 
which Wordsworth would return to paganism, that he may 

"Have sight of Proteus rising from the sea 
Or hear old Triton blow his wreathed horn." 

"And so," Masson continues, "with the poetical mode of 
thought to this day. Every thought of the poets, about 
whatever subject, is transacted not mainly in propositional 
language, but for the most part in a kind of phantasmagoric 
or representative language, of imaginary scenes, objects, 
incidents, and circumstances."^ Thus a very recent poet, 
Arnold, starting with the thought that Shakespeare stands 
far above other poets, transforms this thought into a picture, 
sees Shakespeare "o'ertopping knowledge," and then as a 
hill, which in turn is poetized into a mythical giant: 

" For the loftiest hill 
That to the stars uncrowns his majesty, 
Planting his steadfast footsteps in the sea, 
Making the heaven of heavens his dwelling-place, 
Spares but the cloudy border of his base 
To the foiled searching of humanity."^ 

^K. Abraham, Traum und Mythus, pp. 37, 71. 
-Wordsworth, Shelley, Keats, and Other Essays, p. 229. 
^"Shakespeare." 



F. C. Prescott 117 

^'The poet, then," as Professor Woodberry puts It, "seems 
to present the phenomenon of a highly developed mind 
working in a primitive way."^ 

The mental faculty which produces poetry is akin to 
that already described as producing dreams. It might 
be called the phantasy, the fancy, or the imagination; but 
since these terms have been unfortunately extended and di- 
verted to new meanings, it may best be called simply the 
image-making faculty. It will be worth while to consider 
this matter for a moment historically. The faculty before 
us is equivalent to the <^avTao-ia, to which Aristotle attri- 
butes not only dreams but poetry. This Aristotle defines as 
^'the movement which results upon an actual sensation." 
In other words, it is primarily the "after effect of a sensation, 
the continued presence of an impression' after the object 
which exerted ithas been withdrawn from actualexperience."^ 
It is notable that Hobbes, who on this point closely fol- 
lows Aristotle, translates <f>avraaLu by imagination: "For 
aftef the object is removed, or the eye shut, we still retain 
an image of the thing seen, though more obscure than when 
we saw it. And this is it the Latins call imagination, from 
the image made in seeing. . . . Imagination, therefore, is 
nothing but decaying sense. . . . This decaying sense, when 
we would express the thing itself ... we call imagination; 
but when we would express the decay ... we call it mem- 
ory."^ Bacon employs the word imagination in the same 
way, and assigns to imagination poetry as its province.* 
Addison, in his instructive papers in the Spectator on the 
pleasures of the imagination, uses the word, as might be 
expected, in the classical sense and makes imagination the 
mark of poetry. Whereas Aristotle, however, uses phantasy 
to include images derived from all the senses, Addison pro- 
fesses to restrict imagination — though he does not in fact 
entirely so restrict it — to images which "arise originally 
from sight." From their etymology both words, phantasy 
and imagination, apply properly to sight alone; Addison, 

^The Inspiration of Poetry, p. 13. 

^E. Wallace, Aristotle's Psychology, p. Ixxxvii. 

='T. Hobbes, Works, ed. Molesworth, Vol. Ill, pp. 4-6. 

^Works, ed. Spedding, Vol. IV, pp. 292, 406. 



118 Poetry and Dreams 

however, is wrong in formally so restricting this faculty, as 
he himself sees before he finishes his discussion. But "our 
sight," as Addison remarks, "is the most perfect and most 
delightful of all our senses"; hence imagination is mainly 
visual. This, then, is the original use of the word imagina- 
tion in English, as equivalent to the phantasy of Aristotle. 
Coleridge unfortunately did much to influence thought on 
the matter during the nineteenth century; his vague or 
unintelligible observations on the subject, with his attempted 
distinction between fancy and imagination, have served to 
obfuscate rather than to clarify it. Imagination has become 
as indefinite in meaning as poetry itself. 

The original signification, however, still forms the core 
of its meaning, and the best way to secure deiinitenes& of 
thought is to return to it. The poetic imagination is essen- 
tially equivalent to the image-making faculty mentioned 
above. This faculty, as has been said, lies between sense 
and intellect. Its images are derived originally from sen- 
sations; it in turn furnishes material for thought. In ordi- 
nary waking activity it is in a broad sense kept true to 
reality, reproducing images as they have been derived from 
the senses, or combining these in a manner approved by the 
judgment for the practical ends of action. Under other 
conditions, however, — in abstraction, in sleep, in moments of 
poetical production, when senses and conscious intellect are 
in abeyance — then this faculty is freed from responsibility 
to reality, and is put at the service of the desires. It does 
not reproduce reality; it produces fiction. Under proper 
conditions it produces what we call poetry. 

In the prose man, in Benjamin Franklin, for example, 
the imaging faculty works in a prosaic way. It reproduces 
images truthfully or combines them for practical purposes, 
under the supervision of the judgment. In the poet, in 
Bunyan or Shelley, it is constantly and readily placed at the 
service of the desires or aspirations, producing fiction or 
poetry. It is seen in its extreme poetical operation in a 
man like Blake, who easily lost hold on reality, who became 
habitually a dreamer, visionary, or poet. "I assert for 
myself," says Blake, "that I do not behold the outward 
creation, and that it is to me hindrance and not action. 



F. C. Prescott . 119 

*What,' it will be questioned, 'when the sun rises, do you not 
see a round disc of fire something like a guinea ?' Oh ! no, no ! 
I see an innumerable company of the heavenly host, crying, 
'Holy, holy, holy is the Lord God Almighty!' I question 
not my corporeal eye any more than I would question a 
window concerning a sight. I look through it, and not 
with it."' 

"We are led to believe a lie 
When we see with, not through the eye." 

This is the difference between the proseman and the poet. 
The former sees with the eye the world as it is. The latter 
sees through the eye — the same organ differently employed 
— the world as he would wish it to be; — this is what we 
mean by "second sight." The poet also sees truth, but of a 
different and higher kind. "What the imagination seizes 
as beauty," says Keats, "must be truth, whether it existed 
before or not. . . . The imagination may be compared to 
Adam's dream; he awoke and found it truth. "^ 

From what has just been said of the imaging faculty, 
together with what has been said above of poetical creation, 
we may form a new, or at least more definite, conception of 
that "creative imagination " which is ordinarily ascribed 
to the poet. This expression, as employed in current criti- 
cism, is a vague one, covering — perhaps properly for a com- 
plete description — other activities besides the comparatively 
definite one we have been considering here. We have been 
dealing with the core of the matter, however, and when we 
come to understand the "dream-power" of the poet, as 
Emerson calls it,^ the creative imagination will have lost 
most of its mystery. The poet is a creator because, like the 
dreamer, he creates in an ideal world according to our de- 
sires what is wanting in the divinely created world of reality. 
He pictures it through a faculty which he has in common with 
the dreamer. That the operation of this faculty in the 

^A Vision of Judgment. Cf. Shakespeare's "Love looks not with the eye, but 
with the mind." The lover, as Plato believed, is a kind of poet; cf . p. 1 19, below. 

^Letters, ed. Forman, 1895, pp. 52, 53. 

^" Stand and strive" — thus Emerson apostrophizes the poet — "until, at 
last, rage draw out of thee that dream-power, which every night shows thee is 
thine own." Essays, "The Poet." 



120 Poetry and Dreams 

dreamer is fairly well understood suggests that its operation 
in the poet is not beyond our comprehension. Its poetical 
operation is perhaps difficult of analysis, because, like that 
of the dreamer, it is an unconscious operation and cannot be 
readily observed. Our parallel, however, suggests obvious 
lines of investigation which may lead to a definite compre- 
hension of the creative imagination, as it works not only in 
dreams but in poetry. 

It may be objected that the explanation of poetry 
offered in the preceding pages is quite theoretical, formed 
without sufficient regard for actual poetry; that in any given 
poem there is much which is not at all referable to the kind 
of operation that I have been describing; indeed, that there 
are many poems which show no trace of this operation and 
bear no apparent relation to it. In considering this objec- 
tion the reader will in the first place kindly keep in mind 
what has already been stated, — namely, that this explana- 
tion does not apply to all that goes under the name of poetry, 
but only to the poetry of primary inspiration. He will 
remember also that even the inspired poet is not always 
inspired. He is inspired only in those poems or parts of 
poems that are most vital and characteristic; elsewhere he is 
himself only copying the forms of inspiration. He writes 
perhaps through a long poem in one verse-form; this uni- 
formity tends to conceal the fact that the diflterent parts of 
the poem are quite different in their nature and inspiration. 
Some parts are written with vision; they come from the 
deep unconscious sources that have been referred to. Others 
are written with the conscious mind; these are the work of 
the skilful artificer, not of the true poet. The latter parts 
may contain material of any sort — the actual history and 
description of Scott or the philosophy which we could so ill 
spare from Shakespeare — whatever the writer may make 
congruous with his inspired portions and with his verse- 
form. By no means all of any poem, therefore, will be poetry 
in the sense in which we are using the term. One is reminded 
of Coleridge's dictum that "a poem of any length neither can 
be nor ought to be all poetry," and of Poe's that a long 
poem is a contradiction in terms. 

A distinction "must be made between the poetry origi- 



F. C. Prescott 111 

nally formed in the mind of the poet and the poem as it is 
finally committed to writing. The former is a vision, like a 
dream of brief duration, coming in the moments of rapture; 
the latter is the product of extended labor. ^'^ A true work 
of art," says Carlyle, "requires to be fused in the mind of 
its creator, and, as it were, poured forth (from his imagi- 
nation, though not from his pen) atone simultaneous gush."^ 
Shelley expresses much the same thought: "The toil and 
delay recommended by critics can be justly interpreted to 
mean no more than a careful observation of the inspired 
moments and an artificial connection of the spaces between 
their suggestions by the intertexture of conventional expres- 
sions — a necessity only imposed by the limitedness of the 
poetical faculty itself; for Milton conceived the Paradise 
Lost as a whole before he executed it in portions."^ 

The relation between the poetic vision and the literary 
product will be further explained by another reference to 
the dream theory. The poetic vision is perhaps subjected 
to a process similar to that described as taking place in 
dreams under the name of Secondary Elaboration.^ This is 
due to the action of the censor and arises "from the activ- 
ity, not of the underlying dream thoughts, but of the more 
conscious mental processes. . . . When a dream is appre- 
hended in consciousness [that is, recollected on waking], it is 
treated in the same way as any other perceptive content, 
and is therefore not accepted in its unaltered state, but is 
assimilated to pre-existing conceptions. It is thus to a cer- 
tain extent remodeled so as to bring it, so far as is possible, 
into harmony with the other conscious mental processes."'* 
So when the poet brings his vision out of the region of in- 
spiration into the everyday world, when he comes con- 
sciously to recollect and record it, he doubtless inevitably 
modifies it to bring it into harmony with his ordinary waking 
thought. When, for example, Shelley recorded his vision in 
whatTrelawny describes as a "frightful scrawl," even in this 
scrawl made almost in the moment of rapture, he doubtless 

^Essays, "Richter." 

^Defense of Poetry, ed. Cook, p. 39. 

'Die Traumdeutung, VI (h). 

'E. Jones, American Journal of Psychology, Vol. XXI, p. 297. 







122 Poetry and Dreams 

lost something of his original inspiration. And when the 
next morning — to use his own words — he made from this 
rude sketch a finished drawing, he doubtless lost still more. 
He had to find words for his vision in the language of this 
world, he had to mould it in a conventional metrical form, 
he had to give it local habitation in a world of prose. 
There was more poetry in Shelley's heart than could find 
expression in the finished lyric. "The most glorious poetry 
that has ever been communicated to the world," says Shel- 
ley himself, "is probably a feeble shadow of the original 
conceptions of the poet."^ Truly — to paraphrase Emerson 
— it is in the soul that poetry exists, and our poems are poor, 
far-behind imitations. At best parts of them are faintly 
animated by the authentic poetical inspiration, y 

IV 

We must now return to those "desires of the mind," as 
Bacon calls them, which supply the motives to poetical ac- 
tivity. Every man may be regarded as made up of those de- 
sires which form his native and basic character — of those 
"cravings," to use Nietzsche's phrase, which "constitute his 
being."^ These are constantly changing, some quickly 
passing, others perhaps long remaining; but at any moment 
each man has a certain number of cravings, which, as 
Nietzsche says, call for sustenance; he has a certain number 
of demands upon life which he wishes to have satisfied in his 
experience. These demands are of all sorts from the per- 
sonal and immediate bodily desires, like those for food and 
drink, to the most elevated aspirations — like the one, for 
example, which Matthew Arnold insisted upon, that reason 
and the will of God shall prevail. The main desires are 
those which serve the preservation of life and the propaga- 
tion of the species. Perhaps about these all the others 
gather; the others are these great main desires extended, 
specialized, and diffused. Whatever their nature, higher or 
lower, their working is the same for our purposes if a man 
desires them with heart and soul. These desires form his 
character, they furnish the motive energy for his life. They 

^Defense of Poetry, ed. Cook, p. 39. 
=^The Dawn of Day, p. 116. 



F. C. Prescott 123 

set in motion his activities, these being calculated to secure, 
if possible, the appropriate gratification. 

Our comfort and happiness, we may presume, comes 
from such gratification. That man would be completely 
happy whose desires naturally aroused the proper activities, 
and whose activities successfully attained their end in grati- 
fication; between whose desires and experience there was 
perfect correspondence. On the other hand, a man would 
be entirely comfortable in mind and body if his desires 
could be eradicated; he might approach happiness by elim- 
inating his desires, for, as Carlyle observes, you get the 
same result either by increasing the dividend or by de- 
creasing the divisor. Complete happiness, however, is 
denied in both these directions; not even the most for- 
tunate man finds all his desires gratified; and, on the other 
hand, by no sort of stoicism can man reduce his demands on 
life to the point of vanishing. Thus every man inevitably 
has his desires, some of which must be satisfied at the peril 
of his life, others of which are only a little less imperative, all 
of which are insistent. 

Of the whole number of desires some are gratified, and 
thus ended; others, in seeking or contemplating gratifica- 
tion, encounter obstacles, giving rise to disappointment, 
hunger, and pain of heart. 

These obstacles arise in outside circumstances in vari- 
ous ways. A man may desire something, act in order to 
obtain it, and find it literally snatched away from him by 
another. He may see that gratification is impossible and 
not act at all; the obstacle in this case arises in his own mind 
antecedent to action. He may wish for something that 
is physically impossible to obtain — to add a cubit to his 
stature or to bring back his departed friend. More often, 
however, he meets not a physical but, we may say, a moral 
obstacle. He wishes for something which he does not think 
it right, which he knows that others will not think it right, 
that he should try to obtain. He must consider appearances, 
custom, moral obligations, laws human and divine. Thus 
a man may be prevented from going to church in tennis flan- 
nels, or proclaiming his real opinion on trial marriages, or 
bearing false witness against his neighbor, though he may 



124 Poetry and Dreams 

have the strongest impulse toward any of these things. The 
obstacle is not actual and physical; it exists only in his own 
mind in his moral scruples; it none the less prevents the 
satisfaction of his desire. 

Thus there arises a conflict between the individual's 
impulse and his regard for the authority of what in sociology 
is called the herd. Life sometimes seems a psychic war 
between man and society, with battles waged on the field of 
the mind, — that is, in the mind of the single individual, — 
blows, even death blows, being given upon this field. The 
conflict runs through life. Conduct is the result of a series 
of compromises or adjustments between impulse on the one 
hand and authority, duty, or conscience, on the other. In 
dress, for example, this is symbolized; in dress we express 
our own taste within the limits of fashion. In our writing 
we give utterance to our own thought and feeling in accord- 
ance with the traditions and usages of language in the prosaic 
and poetic styles. In manners we act as we like, so far as 
our breeding or training will allow. In moral matters we 
follow the devices and desires of our own hearts, so far as our 
moral obligations will permit. There is everywhere this 
conflict between impulse and authority, resulting in compro- 
mises more or less satisfactory. The Mill on the Floss is 
a study of such a conflict, in which the individual, the envi- 
ronment, and the reaction of one upon the other, with its 
results, are put before us by a master. 

Our desires are primary and innate, our regard for out- 
side opinion acquired. The savage is a man of ungoverned 
passions; civilization is a long training in self-government; 
the civilized man has come to feel the moral obligations 
sensitively and to respond to them by second nature. This 
response, however, never becomes better than second nature; 
our first nature being always to follow our own desires. In 
the same way the child is morally still in the savage state. 
He is born with his own native character, completely an in- 
dividual. He expresses himself naturally and lawlessly in 
acts and speech. He satisfies his desires selfishly, eating 
and sleeping, and as he grows older, loving his mother who 
feeds and cares for him — in this way first learning what 
love is. He has no altruism, frankly disliking his rivals, 



F. C. Prescott US 

perhaps his brothers, who interfere with him, — having no 
compunction, as investigation has shown, in wishing them 
removed by death. Soon, however, he begins to feel the 
force of authority, and to learn from parents and playmates 
the meaning of duty, obligation, and manners. "Shades 
of the prison-house begin to close upon the growing boy," and 
"the years bring the inevitable yoke." His education is a 
long training in the government of the impulses, in repres- 
sion, — a conservative and conventionalizing process under- 
taken by society in its own interest. Youth is subdued by 
age until youth becomes age; the young man becomes not 
merely an individual, but a member of society, helping in 
turn to impose the authority of society upon others. Thus 
the child, we may say, the moment he is born begins to die. 
The spirit first animates the mortal clay and then is quenched 
by it. For the spirit of life is in these impulses, and the hand 
of authority is the hand of death. The dying is life-long, 
however; it is, as we have seen, a protracted conflict: 

"Life, like a dome of many-colored glass, 
Stains the white radiance of eternity 
Until death tramples it to fragments."^ 

In waking hours, in hours of attention and action, man 
feels his connection and responsibility; he feels the full 
weight of authority. In sleep, in abstraction, in solitude, 
he feels this weight fall away; he becomes an individual; 
he begins to dream. As dreamer and poet he returns, as 
we have seen, to childhood and the individual life, — to 

"Those first affections. 
Those shadowy recollections. 
Which, be they what they may, 
Are yet the fountain light of all our day 
Are yet the master light of all our seeing."^ 

This is a truth which all of us except the poets have 
forgotten — that life and vision and poetry, which belong to 
us all until we die, belong in fullest measure to childhood. 
We see it symbolized in the early religious paintings of 
the holy child in his mother's arms, his head surrounded by 



^Shelley, Adonals." 

Wordsworth, "intimations of Immortality.' 



126 Poetry and Dreams 

the halo, with the Inscription, "I am the light of the world." 
We read it in the quaint poems of Vaughan who, shining in 
his angel-infancy, 

" Felt through all this fleshly dress 
Bright shoots of everlastingness." 

We read it everywhere in Wordsworth, above all, in the 
wonderful Ode, which is its best exposition: 

"Heaven lies about us in our infancy! 
Shades of the prison house begin to close 

Upon the growing boy. 
But he beholds the light, and whence it flows, 

He sees it in his joy; 
The Youth who daily further from the East 
Must travel, still is Nature's priest, 

And by the vision splendid 

Is on his way attended; 
At length the Man perceives it die away 
And fade Into the light of common day. 



**Thou whose exterior semblance doth belie 
Thy soul's immensity; 
Thou best Philosopher, who yet dost keep 

Thy heritage, thou Eye among the blind. 
That deaf and silent, read'st the eternal deep. 

Haunted forever by the eternal mind, — 
Mighty prophet! Seer blest! 
On whom those truths do rest. 

Which we are toiling all our lives to find. 
In darkness lost, the darkness of the grave; 
Thou, over whom thy Immortality 
Broods like the day, a Master o'er a Slave, 
A Presence which is not to be put by; 
Thou little child, yet glorious in the might 
Of Heaven-born freedom on thy being's height, 
Why with such earnest pains dost thou provoke 
The years to bring the inevitable yoke. 
Thus blindly with thy blessedness at strife? 
Full soon thy soul shall have her earthly freight, 



F, C. Prescott 127 

And custom lie upon thee with a weight, 
Heavy as frost, and deep almost as llfe!"^ 

The true poet is born, not made. The acquirements 
which are so much in demand for practical and social ends 
come by education; the impulses which are the life of genius, 
especially of the poetic genius, are innate, a heritage through 
childhood. The possession of these in a marked degree and 
quality, which distinguishes those we call specially poets, 
comes as a gift from nature. 

The desires of mankind furnish the energy which moves 
the world and makes for progress. In each man they pro- 
mote his activities and lead to accomplishment, inspiring 
him to find a way to this and as a means to invent the useful 
arts. "Magister artis ingenique largitor venter."^ Neces- 
sity is the mother of invention — not only in the useful arts 
but in the fine arts also. It is these desires, as has been said, 
which inspire dreams by night and by day, including the 
dreams of the poet. Not finding outlet in activity and de- 
nied actual gratification they provide for themselves a fic- 
tional gratification, creating through the imagination what 
is wanting in reality. They create an ideal world, parallel 
with, but above and beyond that of reality; "a purified form 
of reality," according to Aristotle, "disengaged from ac- 
cident, and freed from conditions which thwart its devel- 
opment";^ — an ideal world, which, we may imagine, through 
some pre-established harmony between mind and nature, the 
world of reality tends to approach and grow into. Those 
arts in which this dream power is at work we call the fine 
arts; they have what we call ideal beauty, and give us a 
pleasure of gratification. 

These desires do not, however, express themselves in 
dreams or poetry unhampered — except, we may imagine, in 
children. They meet that opposing force of authority which 
gives rise to the censor of the dream theory and to the cor- 

^Compare Wordsworth, "Composed upon an Evening of Extraordinary- 
Splendour and Beauty," IV, with its reference to dreams; "Personal Talk"; 
"Prelude," Book II; Shelley, "A Lament"; Hood, "l Remember"; Gray, "Eton 
College"; Longfellow, "The Hanging of the Crane." 

Tersius, Prologue, I, 10. 

^Butcher, Aristotle's Theory of Poetry, p. ISO. 



128 Poetry and Dreams 

responding regulative, controlling, and disintegrating force 
which is at work in the production of poetry. Here again 
life anirtiates the mortal clay and is in turn quenched by 
it. The poetic spirit finds its incarnation and partial ex- 
pression in the fictions and conventional forms which we call 
poetry. In poetry the word is made flesh. 

We have been considering mainly the individual poet. 
We may perhaps regard man as a microcosm of mankind, 
and the larger life of mankind as the resultant from the same 
conflict of opposing forces, — between the individual and 
society, between men taken separately and men taken to- 
gether as a unit. We may perhaps regard imaginative liter- 
ature as a whole — the literature, for example, of a period or 
a nation — as determined by these same opposing forces. 

The terms classicism and romanticism have been com- 
rhon in literary history and criticism. They have been often 
abused and often used vaguely. Every student of literary 
history, however, knows that they relate to actualities, 
that they serve to name, If not to explain, certain observed 
facts and tendencies in literature. The difficulty is not 
with the terms, but with the definition or explanation of 
them. Accounts of the so-called "romantic movement," for 
example, give Instances and characteristics which everyone 
feels to be somehow "romantic" and related, but do not 
amount to satisfactory explanations, because they do not 
unify the phenomena by bringing them under a cause or 
principle. The principles which best explain romanticism 
and classicism are well stated in two words by Walter Pater, 
as "the principles of liberty, and authority, respectively."^ 
These principles. Pater says, are not mutually exclusive, but 
rather complementary. "However falsely those two ten- 
dencies may be opposed by the critics, or exaggerated by 
artists themselves, they are tendencies really at work at all 
times in art, molding it, with the balance sometimes a little 
on one side, sometimes a little on the other, generating, re- 
spectively, as the balance inclines on this side or that, two 
principles, two traditions. In art and in literature."^ Lit- 
erature, in other words, is the result of a conflict between 

^Appreciations, "Postscript." 



F. C. Prescott 129 

the individual impulse, the life-giving and progressive prin- 
ciple, on the one hand, and the power of authority, the con- 
trolling and conservative principle, on the other. Both of 
these forces are always at work; but according as one or the 
other has in any period the upper hand, we call that period 
romantic or classical. 

The literature of England and generally of Northern 
Europe is romantic; that is, in the northern literature the 
vital impulse has always more than held its own against the 
force of authority. The conflict, however, has been strenu- 
ous. The northern genius expressed itself characteristically 
in the Gothic architecture of the Middle Ages. We can 
understand this expression if we think of these northern 
peoples as they first appeared in history, full of youth and 
life and energy, with strong bodies and strong emotions; 
if we think of them subjected, in a comparatively brief time, 
through their introduction to civilization and Christianity, 
to the control of older laws and the ordinances of a religion 
which placed the main emphasis on the mortification of the 
flesh. Their pent energy expressed itself in this architec- 
ture, the product of great genius under unwonted pressure; 
it was forced up into the points and pinnacles, broken into 
the colors of the windows, tortured into the grotesque forms 
and monstrous figures of the decorations. It subjected itself 
to form — to a form, however, which it seems to toler- 
ate uneasily, which it threatens to throw off in order to secure 
its liberty. This is characteristic of the northern art and 
literature, which retain a wildness, grotesqueness, and 
freedom to the present day. 

We may be sure that the human creative energy, like 
energy in every other form, comes not constantly but inter- 
mittently, or in waves, — waves century long, however, so 
that we can look back over only a small number of these in 
our literary history. The Elizabethan period felt such an 
influx of energy. It was a time of individualism, of youth, 
of progress, and therefore, as we should expect, a time of in- 
itiative, activity, curiosity, invention, imagination. "To 
vent the feelings, to satisfy the heart and eyes, to set free 
boldly on all the roads of existence the pack of appetites 
and instincts, this," says Taine, "was the craving which 



130 Poetry and Dreams 

the manners of the time betrayed."^ In the world of action 
it produced men like John Smith, a kind of great boy, as 
fresh, active, and adventurous as Ulysses. In the world of 
letters it produced men like Christopher Marlowe, the type 
of genius fresh and uncontrolled, — a man who 

"Had in him those brave translunary things 
That the first poets had."^ 

Its writers were full of passion, originality, and imagina- 
tion; they were impatient of form as form, having a natural 
rather than a traditional art; as artists they were naive, 
even boyish, playing and experimenting with literary forms 
and with language, fond of the verbal conceits and jingles 
that boys delight in. Shakespeare is a good representative 
of this remarkable time. 

While Shakespeare lived, however, the wave began to 
recede, and in the Jacobean writers passion grew pale and 
imagination feeble. The force of authority asserted itself. 
Ben Jonson and his classical followers were not satisfied 
with Shakespeare's natural art; to them Shakespeare wanted 
art. "Sufflaminandus erat," said Jonson,^ — "he ought to 
have had the brakes put on him" — and this sums up the atti- 
tude of authority toward Shakespeare and its hostility to 
the romantic spirit. Dryden's expression, however, may be 
added. Representing the adult and Frenchified criticism of 
the Restoration, with the air of a man who has grown and 
traveled, he says of the boyish exuberance of the Elizabeth- 
ans — "Their wit was not that of gentlemen," and "it fre- 
quently descended to clenches." 

The classical critics found standards for judging the 
Elizabethans where they are usually found — in the past. 
The effort of authority is always to bind the present by the 
past. Modern writers, it should be noted, may return to 
the classics for two purposes, — some, like Marlowe and 
Keats, to stand "up to the chin in the Pierian flood," and to 

^History of English Literature, Book II, Chap. I, Sec. 3. 

^Drayton, "To H. Reynolds." 

^Jonson, Timber, and Dryden, Dramatic Poetry of the Last Age. Both 
Jonson and Dryden, in speaking of Shakespeare, more often acknowledge their 
kinship and admiration; but then they are not speaking with the voice of author- 
ity. 



F. C. Prescott 131 

live with those first poets who "are yet the fountain light of 
all our day"; others, like Jonson and Pope, to find laws and 
precedents. The former go generally to Homer and the 
Greeks, the latter to the Latin poets, particularly to Horace. 
The main characteristic of the writers in our so-called classi- 
cal period was not that they returned to the classics, or 
that their work is marked by traits conspicuous in the clas- 
sics, but that they made authority the guide of life and sought 
authority in Homer and Virgil, Aristotle and Horace. 

"Hear how learned Greece her useful rules indites, 
When to repress, and when indulge our flights. 

"Learn hence for ancient rules a just esteem; 
To copy nature is to copy them."i 

The period from the Restoration to the end of the eighteenth 
century is best explained by this key idea. It was social, 
frowning upon individuality — a time of rigid conventional- 
ity, when one man was expected to be like another in dress, 
manners, language, and style. It was sophisticated and 
cynical, — as if age had come upon it since the time of 
Shakespeare, — "a decrepit, death-sick era," Carlyle calls 
the latter part of it. It was reflective and critical rather 
than progressive and creative. It was strong in its common 
sense, which recognizes the demands of society. In litera- 
ture it was an age of prose and reason; it produced satires 
and novels; it perfected the heroic couplet. It produced 
men like Pope and Chesterfield and Franklin, sane men, who 
saw no visions and had no illusions. A very valuable period 
this no doubt was too; not to be underestimated, but rather 
to be seen for what it is; for, if man cannot live by bread 
alone, in this world at any rate bread is necessary; man must 
think as well as dream; art is necessary as well as inspira- 
tion, and we may suppose the eighteenth century well spent 
in criticism and reflection. 

The nineteenth century, however, broke the bonds of 
authority and reasserted the power of the individual. Rous- 
seau sounded the new note in the first page of his Confessions: 
"I am not made like any one else, I have ever known; yet 

^Pope,"Essay on Criticism." 



132 Poetry and Dreams 

if I am not better, at least I am different." These words 
introduce another era of creative energy: 

"Bliss was it in that dawn to be alive; 
But to be young was very heaven."^ 

We need not stop to characterize this "romantic movement," 
with its rejuvenation of English life and literature, except 
to note that one of its traits was a strain of melancholy, 
morbidity, and madness, which hardly finds its parallel in 
the earlier romantic era. The author of Hamlet must have 
sounded the gloomy depths of the human mind, but he always 
kept up appearances. The abandonment of Rousseau, of 
Werther and Rene and Childe Harold, is new in the nine- 
teenth century. There is an apparent difference in mental 
constitution between the men of letters of this period and 
those of the eighteenth century. The latter — Addison, 
Steele, Pope, Fielding, Johnson, Goldsmith, Burke — what- 
ever their bodily infirmities, were pre-eminently sane in 
mind. Even Swift, whose insanity was probably due to 
physical causes, could look at life clearly. The romantic 
writers, with the exception of Scott, — Chatterton, Cowper, 
and Blake; Wordsworth,^ Coleridge, and Southey; Byron, 
Shelley, and Keats; Hazlitt, Lamb, and DeQuincey — all 
these were in some way mentally eccentric or abnormal. 
For one reason or another they would have seemed " strange " 
to a belated observer from the polite and sensible eighteenth 
century. It would seem — if a conclusion can be drawn 
from evidence like this — that something in the romantic 
temper, with its individualism, its passion, its fondness for 
solitude and hatred of society, were conducive to mental 
aberration. Perhaps an explanation for this will be found 
in the following pages. 

We have seen that life may be regarded as a conflict 
between the individual and society; that poetry has its 
origin in a conflict between the poet's egoistic desires or 
impulses on the one hand and his regard for what we have 
called authority on the other; that, to some extent at least, 

^Wordsworth, Prelude, Book XI. 

^Some readers may object to the inclusion of Wordsworth here, and I have" no 
objection to omission. 



F. C. Prescott 133 

literature may be explained as resultant from a similar con- 
flict between similar opposing forces. In this same conflict 
will perhaps be found the explanation of another peculiarity 
of poetic production which we have not yet considered. Let 
us see. ^ 

V 

We shall have to return again to the desires of the 
mind. Satisfied desires are ended. Unsatisfied desires give 
rise to feelings of ifwsatisfaction, to unpleasant or pain- 
ful sensations, to some degree of emotional disturbance, — 
if this disturbance is severe, to what we call passion. This 
is what we have in mind when we say colloquially that we 
are passionately fond of a thing, or simply that we have a 
passion for it.^ The word passion is commonly applied to 
one of our main or fundamental desires, the sexual one, and 
only when satisfaction of this desire is deferred; the satisfied 
lover is no longer passionate; it is only the lover who is 
separated from his mistress who is consumed by passion. It 
may be thought that the passion of love is mainly pleasurable 
but observation will probably show, as a consideration of its 
nature will suggest, that its main element is one of dissatis- 
faction and unpleasurable.^ As this is the one of our funda- 
mental desires which most often conflicts with external 
authority, in some one of its forms — as this desire is most 
often subject to repression — it probably is most often re- 
lieved in dreams and poetry.^ A great part of imaginative 
literature — not merely love poems and tales, but much 
which on its face does not relate to this subject — is probably 
a sublimated expression of the sexual desire. This throws 
light also on the analogy, which is suggested by language 
and by other evidence, between actual or physiological 

^The reason why we say we are "mad" or "crazy" about a thing will appear 
in a moment. 

^Cf. Freud, Three Contributions to the Sexual Theory, translated by A. A. 
Brill, p. 60. 

'*This statement, as far as it concerns dreams and neurotic manifestations, is 
supported by the investigations of Dr. Freud. Dr. Freud has been blamed for the 
preoccupation of his psychology with the sexual. It may be noted that imagina- 
tive literature is preoccupied with the same subject, particularly plays and novels. 



134 Poetry and Dreams 

creation and imaginative creation; this analogy is not 
fanciful/ 

The unsatisfied lover proverbially breaks out in verse, 
taking refuge in this indirect expression and gratification 
when others moi^ actual are denied him. The lover on the 
authority of Shakespeare is one of those who are of imagina- 
tion all compact. According to Shakespeare, also, unsatis- 
fied love leads to madness. Romeo is thought next door to 
it. "Why, Romeo, art thou mad?" Benvolio asks him, 
and Mercutio calls, "Romeo! humours! madman! passion! 
lover!" Hamlet is in love, and thought by Polonius, who 
is doubtless not entirely wrong, to be "from his reason 
fall'n thereon." Hamlet, by the way, also has "bad dreams." 
Ophelia goes mad for love: 

"O heavens! is't possible, a young maid's wits 
Should be as mortal as an old man's life? 
Nature is fine in love, and where 'tis fine, 
It sends some precious instance of itself 
After the thing it loves." 

Ophelia's songs, moreover, are the appropriate expression of 
her thwarted love and consequent madness — a natural 
poetry, well illustrating, though they are only those of a 
dramatis persona, what we have said of the origin of poetry.^ 
Ophelia illustrates also some earlier lines of Shake- 
speare, for she is at once lunatic, lover, and poet: 

''Lovers and madmen have such seething brains. 
Such shaping fantasies, that apprehend 
More than cool reason ever comprehends; 
The lunatic, the lover, and the poet 
Are of imagination all compact."* 

There is much meaning condensed in the celebrated pas- 
sage in which these lines occur, and it may be reperused with 

^See the section on this subject in Ribot, L'Imagination Creatrice, p. 62. 

^It may be urged that, as Mrs. Jameson suggests, Ophelia is here recalling 
snatchesof old ballads heard in infancy; but the expression is at any rate a poetic 
one, in the sense of this discussion; and, being doubtless in part at least extempore, 
it represents just that fusion of elements from childhood and recent experience 
which we have found to be characteristic of the poetic expression in general. 

'Midsummer Night's Dream, Act. V, Sc. 1. 



F. C. Prescott 135 

profit by anyone who has followed this discussion thus far.^ 
The point in it to our present purpose is the common char- 
acter which Shakespeare attributes to the lover, — or may 
we say generally the man unsatisfied? — the madman, and 
the poet. 

Not every man who wants gratification, of course, is 
mad in the ordinary sense of the term. The fact is only 
this: that the conflict we have described between the desires 
and fact or authority produces friction, heat, emotional dis- 
turbance, which tends to impede and incapacitate "cool 
reason," — which, if carried far enough, will completely 
overthrow it and end in irrationality and madness. The 
mental condition of ecstasy may even be brought on arti- 
ficially — as it was by St. Simon and others — through fast- 
ing, sexual abstinence, and isolation. Now the conflict 
between desire and fact or authority is characteristic of the 
poet, and in the poet also it produces friction, emotional 
disturbance, a suspension, even an unbalancing of the 
reason — what we call the poetic madness. 

Light is thrown on this subject by recent investigations 
in mental pathology. Dr. Freud and others have-found that 
many cases of psychoneurosis, ranging from slight mental 
disturbances to what would amount to legal insanity, are due 
to the noxious effects of repressed material in the mind. In 
these cases the patient has at some time, perhaps even in 
childhood, felt certain strong desires; he has found these 
for some reason incompatible with the facts of life, and has 
consequently repressed them. They are thus driven back 
into unconsciousness; the patient himself has no knowledge 
of them. They continue operative, however, causing various 
neurotic symptoms — day dreams, violent hallucinations, 
involuntary speeches and actions — which provide for them, 
so to speak, a symbolic fictional gratification.^ For example, 
the speeches and actions of the patient, through a species of 

^It is notable that this passage occurs in the most poetical of Shakespeare's 
dramas — one which he entitled a dream, and which has many dream qualities. 
One might imagine that his attention had been called to the "dream power" by 
his own mental experiences, and that he pondered the subject which we are trying 
to discuss here. 

'^See K. Abraham, Jahrbuch fiir psychoanalytische und psychopathologische 
Forschungen, Vol. II, Uber hysterische Traumzustande." o 



136 Poetry and Dreams 

"displacement" or transference, one thing standing for or 
symbolizing another through obscure associations, become 
an unusual or abnormal outlet for unconscious impulses, to 
which on their face they seem in no way related. Thus 
nervous or hysterical manifestations which once seemed 
meaningless and mysterious are now traced to their definite 
origin in the patient's mental processes. If these uncon- 
scious desires are brought to light, rationalized, and given 
proper expression their noxious influence ceases and the 
strange symptoms disappear; and this fact has supplied a 
cure of practical value in such cases. The repressed material 
forms a "painful arid disturbing element in the organism," 
to use the phrase employed by Professor Butcher in describ- 
ing the Aristotelian katharsis, and the cure consists in the 
"elimination of alien matter." Now to apply this to the 
subject in hand — here is a mental derangement or madness, 
resulting from what may be called mental friction, produced 
by the conflict between desires and obligations. The poetic 
madness is analogous, arising in the same conflict, and 
poetry is in some respects analogous to the neurotic symp- 
toms noted above. Ophelia's songs will perhaps again serve 
to bridge for the reader's mind the gap between the two: we 
may suppose these songs to be not only natural poetry, as 
we have seen, but the manifestation of a neurosis. 

So, if, as Keble says, "to innumerable persons poetry 
acts as a safety-valve, tending to preserve them from mental 
disease," it is from a disease of this sort, from what would 
be called in modern pathology a neurosis. As the reader 
will remember that dreams have a similar function, it is not 
remarkable that Dr. Freud has found that the dreams of his 
neurotic patients deal largely with the same subject-matter 
which gives rise t,o their neurotic symptoms. So much is 
this true that the patient's dreams supply one of the means 
regularly employed in discovering the hidden causes of the 
disease. It is not strange, moreover, that poets should be, 
as we have seen, great dreamers, since their mental condition 
is one approaching a neurosis. 

This will help to explain recent works, like those of 
Dr. Nordau and Lombroso, which attempt to show that 
poets are often "degenerates," and the ease with which they 



F. C. Prescott 137 

supply evidence lending apparent support to their theories. 
Such evidence can be found in the lives of many poets. 
These poets are not, however, degenerates;^ they are not 
even necessarily to be called abnormal or diseased. The 
mental sanity of the poet has been often questioned. Lamb, 
in a well-known essay, defends the "sanity of true genius."^ 
Heine suggests the opposite view: "Oder ist die Poesie viel- 
leicht eine Krankheit des Menschen, wie die Perle eigent- 
lich nur der Krankheitsstoff ist, woran das arme Austertier 
leidet."^ It is, however, alike vain and unscientific to dis- 
cuss the question whether poets are mentally diseased or 
not, the line between mental health and disease being a vague 
or imaginary one; and the poet at most only showing in 
greater degree traits which are common to all men, all men 
being dreamers, poets, and neurotics in some measure. 
We can only say that poets are inevitably subject to mental 
disturbance, which may go so far as to make them "pecul- 
iar" or incapable of discharging the ordinary duties of 
society. 

Let us return to the emotional disturbance regularly 
incident to the production of poetry — to the classical 
poetic madness. This word must apply to various kinds of 
disturbance, — at least to the same disturbance in very 
varying degrees. With Sir Walter Scott we may suppose 
madness to have amounted only to a genial glow, perhaps 
for the reason that his ruling passion was of a mild kind, of 
long duration, and, so to speak, diffused. For, as Keble 
observes, "the mind has its r^drj as well as its iraO-q, — its per- 
manent tastes, habits, inclinations, which, when directly 
checked, are as capable of relief by poetical expression as the 
more hidden and violent emotions."* With a poet like Shelley 
the madness may rise to a higher but temporary disturbance 
— a rapture or even a fine frenzy. With Coleridge, or De 
Quincey, or Foe, it may take peculiar forms because compli- 
cated with the effects of alcohol or opium, resorted to per- 
haps for alleviation, the poetic product in these cases having 

^See the argument in Hirsch, Genius and Degeneration. 
^Essays of Elia, 'The Sanity of True Genius." 
^Die Romantische Schule, 11, iv. 
^The British Critic, Vol. XXIV, p. 439. 



138 Poetry and Dreams 

quite unusual coloring. With Blake it may be an almost 
uninterrupted and life-long ecstasy, to his friends indistin- 
guishable from insanity. Finally, it may lead to, or at 
least be associated with, actual madness, as, perhaps, in 
Cowper or de Maupassant. In the cases of Ben Jonson, 
Swift, and Southey, who were attacked by insanity, we 
cannot be sure what connection, if any, there was between 
the poetic faculty and the mental derangement. In Lamb 
we feel perhaps that the dream power, the poetic madness, 
and the insanity were somehow closely connected. Perhaps 
an average or typical case would be that of Byron, who says 
in Childe Harold: 

"I have thought 
Too long and darkly, till my brain became, 
In its own eddy boiling and overwrought 
A whirling gulf of phantasy and flame." 

Or, as he says in his letter, after speaking of this poem as 
his favorite: "I was half mad during the time of its compo- 
sition, between metaphysics, mountains, lakes, love unextin 
guishable, thoughts unutterable, and the nightmare of my 
own delinquencies."^ We do not know, however, definitely 
what Byron means by this half madness. 

The madness is different in character and degree in 
different poets; but, in some sense and in some degree, the 
true poet will always be mad. We have it on the authority 
of a long line of poets and critics, reaching back to the 
oldest. The locus classicus occurs in the well-known pas- 
sage in the Phaedrus, in which Socrates is made to divide 
madness into four kinds. ^ Of these the first and the fourth 
belong to the prophet and the lover. The second is less 
familiar to us; it is the madness which "purges away ancient 
wrath," emotional excitement being used, apparently in the 
way described by Aristotle, to drive out harmful emotional 
disturbances, by a homeopathic and cathartic method, re- 
storative of mental sanity.^ "He who has part in this gift," 
says Plato, "and is truly possessed and duly out of his 
mind, is by the use of purifications and mysteries made 

iChilde Harold's Pilgrimage, III, vii; Letter to Moore, Jan. 28, 1817. 
''Jowett's Translation, Vol. I, p. 450; cf. Ion, Vol. I, p. 502. 
»Cf. p. 45, note 5. 



F. C. Prescott 139 

whole and exempt from evil." Then comes the poetic 
madness. "The third kind is the madness of those who are 
possessed of the Muses; which taking hold of a delicate and 
virgin soul, and there inspiring frenzy, awakens lyrical and 
all other numbers; with these adorning the myriad actions 
of ancient heroes for the instruction of posterity. But he 
who, having no touch of the Muses' madness in his soul, 
comes to the door and thinks that he will get into the temple 
by the help of art — he, I say, and his poetry are not ad- 
mitted; the sane man disappears and is nowhere when he 
enters into rivalry with the madman." 

Aristotle's expressions on this subject are in substan- 
tial agreement with Plato's, though they introduce a new 
element. Aristotle also believes poetry to be "a thing 
inspired."^ In the Poetics, however, he says it "implies 
either a strain of madness or a happy gift of nature." That is, 
he divides poets into two classes, the e/co-TaTiKot'and the evTrXao-rot 
— on which Keble bases his distinction between the poets 
of primary and the poets of secondary inspiration. Just 
as an actor can get his effect, either by abandoning himself 
and living through all the feelings of the character he repre- 
sents, or, on the other hand, by a cool and deliberate mim- 
icry; so the poet must be either "filled with fury, rapt, 
inspired," or he must be capable, by a flexible assumption 
through conscious art, of writing as if he were inspired. 
Shelley was a poet of primary inspiration. Dryden, on the 
other hand, "had in perfection the evcfyvca, the versatility 
and power of transforming himself into the resemblance of 
real sentiment, which the great philosopher has set down as 
one of the natural qualifications for poetry, but he wanted 
the other and more genuine spring of the art — t6 fiaviKov — 
the enthusiasm, the passionate devotion to some one class 
of objects or train of thought."^ Aristotle thus agrees with 
Plato except that, to cover the facts as he finds them, he 
broadens his conception of poetry to include that of sec- 
ondary as well as that of primary inspiration — just as a 
critic of the whole body of our poetry would have to do 
to-day. Aristotle's expression, however, adds nothing for 

iRhetoric, III, 7; Poetics, XVII, 2. 
^British Critic, Vol. XXIV, p. 438. 



140 Poetry and Dreams 

our purpose; as has been said, we are concerned onlywith the 
cKo-TttTtKot; when they are explained the mysteries of poetry 
will have been cleared up. 

Other expressions to the same effect are common in 
classical writers, and doubtless go back to these passages 
in Plato and Aristotle. "Poetam bonum neminem," says 
Cicero, giving as authorities Plato and Democritus, "sine 
inflammatione animorum existere posse, et sine quodam 
affiatu quasi furoris."^ Plutarch explains verse as arising 
from this madness: "But above all, the ravishment of the 
spirit or that divine inspiration which is called enthusiasmus, 
casteth body, mind, voice, and all far beyond the ordinary 
habit; which is the cause that the furious raging priests of 
Bacchus . . . use rime and meeter; those also who by a pro- 
phetical spirit give answer by oracle, deliver the same in 
verse; and few persons shall a man see starke mad, but 
among their raving speeches they sing or say some verses."^ 
Seneca attributes to Aristotle the saying, "Nullum magnum 
ingenium sine mixtura dementias fuit."^ 

The English poets in turn have taken the idea from the 
classics. Ben Jonson quotes it from Seneca, Plato, and Aris- 
totle;* and Dryden translates from Seneca, "Great wits are 
sure to madness near allied."^ Pope, probably on classical 
authority, attributes to Spleen "the hysteric or poetic fit."^ 
It is unnecessary, however, to suppose that the idea is native 
only to the classics. Our old word wood or zvode, meaning 
mad, is believed to be etymologically connected with wo8, 
a song, and with the Latin vates, a seer or poet, — suggesting 
that recognition of the poetic madness is very widespread 
and older than Plato. So when Drayton writes of Marlowe, 

"For that fine madness still he did retain 
Which rightly should possess the poet's brain, "^ 

and when Shakespeare speaks of the "poet's eye in a fine 

^De Oratore, II, 46; cf. De Natura Deorum, II, 66. 

^Morals, Symposiacs, i, 5. Holland's translation. 

^De Tranquillltate Animi, XV, 16. 

^Timber, ed. Schelling, p. 75. 

^Absalom and Achitophel, I, 163-164. 

*The Rape of the Lock, IV, 60. 

'"To H. Reynolds." 



I 



F. C. Prescott 141 

frenzy rolling," these writers are not necessarily indebted 
to Plato for the idea. Indeed Shakespeare seems to have 
thought most independently and deeply of all on this sub- 
ject, for the passage in the Midsummer Night's Dream, 
taken with lines of similar import in other plays, gives a 
clue to the whole truth in the matter/ 

Wordsworth's lines in The Prelude bear on this, as upon 
other matters we have been considering: 

"Some called it madness — so indeed it was 
If childlike fruitfulness In passing joy, 
If steady moods of thoughtfulness matured 
To inspiration, sort with such a name; 
If prophecy be madness; If things viewed 
By poets of old time, and higher up 
By the first men, earth's first Inhabitants, 
May In these tutored days no more be seen 
With undisordered sight. "^ 

The poet's madness is not, as so many have thought, 
a sign of weakness, abnormality, or degeneration, but rather 
of power. As Professor Woodberry remarks, it "denotes 
nothing abnormal, but is rather an unusually perfect illus- 
tration of the normal action of emotion in a pure form."^ So 
Emerson, seeing in such madness the only escape from Ameri- 
can materialism and conformity, exclaims: "O Celestial 
Bacchus! drive them mad, — this multitude of vagabonds, 
hungry for eloquence, hungry for poetry, starving for sym- 
bols, perishing for want of electricity to vitalize this too 
much pasture, and in the long delay indemnifying themselves 
with the false wine of alcohol, of politics, and of money." 
Nietzsche, likewise, imagines the productive minds of all 
ages seeking madness, which he recognizes as arising from 
the conflict of genius with the "morality of customs": 
"Oh, ye powers in heaven above, grant me madness! Mad- 
ness that I may at least have faith in my own self! . . . 
Doubt is devouring me; I have slain the law, and the law 
haunts me, even so as a dead body does a living being. If 
I am not above the law I am the most depraved of all men. 

^See references in M. Luce, Handbook to Shakespeare, pp. 31-45. 

=^Book III. 

^The Inspiration of Poetry, p. 13, quoting the following from Emerson. 



I 



142 Poetry and Dreams 

The spirit which dwells within me, whence comes it, unless 
it comes from you? Grant me proof that I am yours; 
nothing but madness will prove it to me."^ Thus madness 
is to be desired, even prayed for. It suspends the reason 
and opens the heart; and the heart sees further than the 
head. "From insanity," said Plato, "Greece has derived 
its greatest benefits." 

We have perhaps advanced no great way toward a com- 
plete understanding of the poetic madness. We have made 
some progress, however, if instead of calling it merely a 
"celestial inspiration," we connect it with other things with 
which we are familiar, and recognize in this matter also the 
common character of poetry, dreams, and the manifestations 
of hysteria. The evidence on this head has led us to the 
following conclusions which may be presented here by way 
of summary. Our desires demand satisfaction, and in their 
satisfaction we secure pleasure, relaxation, sanity of mind 
and body. Our desires, however, cannot be completely 
satisfied, nor are we destined to secure complete health and 
happiness. While one desire is being satisfied new ones are 
springing up, keeping in advance, leading to new energy, and 
new activity — to all that makes up our lives as far as action 
and accomplishment are concerned. Some of our desires, 
however, cannot be satisfied, because they conflict with 
fact or authority; thus wanting indulgence or expression 
they are, so to speak, forced back and dammed up. They 
then give rise to conditions of torpidity, tension, inflamma- 
tion — that is, to emotional disturbances, according to their 
nature and importance of varying degrees of intensity. Of 
these disturbances the tension accompanying dreams, the 
neuroses we have mentioned, and the poetic madness are 
alike instances. This condition, moreover, requiring to be 
relieved, or purged, such relief or purgation is afforded in 
dreams and poetry, as we have described, through a shadow 
of satisfaction, which affords a pleasure akin to actual satis- 
faction. Hence the comfort that lies in the writing or reading 
of poetry, and hence one source of the pleasure we derive 
from poetry as from all art; it is a pleasure of satisfaction, 
bearing the same relation to actual pleasure which the ideal 

^The Dawn of Day, Sec. 14. 



F, C. Prescott 143 

bears to the real; one is the ethereal counterpart of the 
other. 

The relief or purgation just spoken of, moreover, is 
accomplished in a manner contributing finally to the good 
of the organism or the race as follows. Poetry, with its 
allied mental productions, presents before our eyes a pic- 
ture, not of the world as it is, but of the world as we wish 
it to be, or — since surely our desires are not meaningless 
but like all else in nature ordered and significant — may 
we not say, not of present reality but of coming reality. 
Poetry looks toward that universal or purified or perfected 
nature of which Aristotle speaks. The poet prefigures the 
world which is to come, and points the path later men are to 
follow — as Moses saw from Pisgah the promised land which 
not he but his people were to occupy. Thus, when man is 
not acting he is seeing; life is sublimated in poetry; and 
men of action give place as leaders to seers and poets. 
"Truly the laurel crown appointed for triumphant captains 
doth worthily, of all other learnings, honor the poet's 
triumph." 



ABSTRACTS 

ON THE NIGHTMARE. Emest Jones, M.D., M.R.C.P. (Lond.) 
American Journal of Insanity, January, 1910. 

In this article, the subject of nightmare receives from the 
able pen of Dr. Jones a most admirable exposition. Under the 
heading, Pathological, Jones discusses the curious indifference 
with which the subject has been viewed by medical science, and 
the consequent failure to treat victims of the disorder with success. 
The reason for this state of affairs, he finds to be a lack of apprecia- 
tion of the intensity of the mental suffering entailed, ignorance 
of the underlying reality, and a general materialistic attitude 
toward mental symptoms in general, and of dreams in particular. 
Even regarded from a physical standpoint, the condition is cer- 
tainly not neglectable, as shown, for example, by the presumable 
occurrence of cerebral hemorrhage during sleep as a consequence 
of alterations in the circulation induced by the agony of bad 
dreams. 

An interesting description of nightmare as given by various 
appreciative writers on the subject, most of whom were them- 
selves victims of the disorder, gives the reader a vivid idea of the 
mental suffering induced by the condition. The dread occurring 
in nightmare is, according to Jones, best denoted by the untrans- 
latable word Angst. It appears that the cardinal features of the 
malady are: 

1. Agonizing dread. 2. Sense of oppression or weight 
at the chest which alarmingly interferes with respiration. 3. 
Conviction of helpless paralysis. 

The Angst has been variously described by writers, among 
whom perhaps Shakespeare stands pre-eminent; as, for example, 

"I, trembling, waked, and for a season after 
Could not believe but that I was in Hell, 
Such terrible impression made my dream." 

The second cardinal feature is a sense of oppression, with a 
dread of suffocation, often reaching an extreme degree of in- 
tensity. 

The third element is a sense of powerlessness, often amounting 
to complete paralysis, representing an effort on the part of the 
victim to free himself from the suffocation. When the dream 
has reached its culmination, there are evidences of the struggle 
through which the afflicted person has been; as, for example, an 

144 



Abstracts 145 

outbreak of cold sweat, heart palpitation, ringing in the ears, a 
sense of pressure about the forehead, and a terror-stricken coun- 
tenance. The following day it is not unusual for the patient to 
suffer from depression, dread, lack of confidence, pain, and weak- 
ness. In some instances, in fact, the attack may continue for 
some time after clear consciousness has been regained. 

There has been much speculation as to the circumstances 
under which the attack takes place. It appears that the most 
probable times for nightmare to appear are either in the early 
part of sleep, or in the semi-waking state toward morning. It 
has been generally accepted that nightmare is more likely to occur 
when the person is sleeping on his back, hence the therapeutic 
suggestion that other attitudes are desirable. Certain writers, 
however, attach relatively little importance to this factor in the 
causation of the attack. 

The pathogenesis of nightmare is the matter of chief interest, 
and regarding this a vast variety of hypotheses have been ad- 
vanced, to certain of the more important of which Jones alludes. 
In general, it appears that writers have mistaken for the true 
cause of the malady factors which simply play a part of varying 
importance in the genesis of a given attack. As in other con- 
ditions, it is altogether probable that an underlying abnormal 
predisposition is excited to activity by a variety of relatively 
superficial causes, Jones strongly maintains that the predisposi- 
tion is the matter of cardinal importance, contrary to the opinion 
of certain other writers who believe that nightmare may also be 
aroused when certain superficial conditions (e.g., indigestion) 
are present. The alimentary, the respiratory, the circulatory, 
and the nervous systems have all been blamed as causative of 
nightmare. Many of the fanciful descriptions of the early writers 
may be dismissed without detailed mention. Others of ancient 
date still retain some popularity, as, for example, the view origi- 
nally advanced by Galen, and later elaborated, that the affection 
arose from gastric disturbances, on the ground that an over-full 
stomach, by pressing on the diaphragm, may act as a source of 
irritation to the nervous system. The supine position has been 
regarded as an efficient agent on the basis of a complicated hy- 
pothesis concerning the mechanism of circulation. A second series 
of hypotheses is concerned with the state of the cerebral cir- 
culation, gastric disturbances in the view of the adherents of this 
theory playing merely a subsidiary role. 

A reaction from these purely physical views took place In 
1855, when Moreau began to lay stress on the psychological aspect 
of the problem. This reaction was entirely justified, since an 



146 The Journal of Abnormal Psychology 

examination of the physical theories shows that very frequently 
the alleged causative factors occur without being followed by 
nightmare; and, on the other hand, that attacks of nightmare 
occur without being preceded by any of the supposed causative 
factors. From such critical observations, it appears that, in the 
first place, such alleged causes often occur in persons who never 
show any symptom of nightmare, as, for example, in a person suffer- 
ing from gastric cancer, who may even add to this causative factor 
the habit of sleeping on the back without the slightest trace of 
nightmare; whereas, other sufferers, scrupulously regarding their 
diet and methods of sleeping, may still suffer to the same degree 
as if no such precautions had been taken. It therefore follows 
on empirical grounds that the phenomenon of nightmare is in- 
adequately explained by the foregoing physical factors. 

The essential manifestations of nightmare must be regarded 
as mental, dominated by an acute feeling of Angst, which in this 
connection must be considered a distinctly pathological phenom- 
enon. Angst is, in general, closely connected with sexual feeling, 
and especially with its pathological repression. If the analysis 
of dreams shows, as maintained by Freud, that in all cases they 
represent the fulfilment in the imagination of some desire, usually 
repressed during the waking hours and that violent mental con- 
flicts result therefrom, it naturally follows that "the malady 
known as nightmare, is always an expression of intense mental 
conflict centering about some form of repressed sexual desire." 
Underthis view Jones believes that the diverging theories of night- 
mare may best be reconciled. He brings in support of his argu- 
ment a number of significant cases described in the literature, 
which under a searching psychoanalysis fall into the category of the 
y/ngj-^ neurosis in the Freudian sense. The conclusions of this eru- 
dite paper are summarized in the closing paragraph, as follows: 
"That nightmare is a form of Angst attack, that it is essentially 
due to an intense mental conflict centering around some re- 
pressed component of the psycho-sexual instinct, and that it 
may be evoked by any peripheral stimuli that serve to arouse 
this body of repressed feeling; the importance, however, of such 
peripheral stimuli in this connection has in the past been greatly 
overestimated as a factor in the production of the affection." 

E. W. Taylor. 



I 



REVIEWS 

ELEMENTS OF PHYSIOLOGICAL PSYCHOLOGY, By GeOTge TrUVt- 

bull Ladd and Robert Sessions Woodworth. New York, Charles 
Scribner's Sons, 1911. Illustrated; pp. xix, 704. 

The subtitle of this timely revision of Professor Ladd's book 
of like name, published twenty-iive years ago, is "A Treatise of 
the Activities and Nature of the Mind, from the Physical and 
Experimental Points of View." It is, however, characteristic of 
the trend of things psychological that this treatise of ''the mind" 
is very largely a discussion of the functions of the nervous system — 
physiology, if there be any physiology; and for progress this is 
certainly well. Ninepagesof the 723, the last chapter in the book, 
is concerned with "the reality and unity of the mind," and has 
a minimum of neural reference. 

The book consists of three parts, respectively "The Nervous 
Mechanism," " Correlations of the Nervous Mechanism and Mental 
Phenomena," and "The Nature of Mind," the first two concti- 
tuting 625 pages. As a treatise on mental process, then, as some- 
thing distinct and different from consciousness, one is somewhat 
surprised to read in the second page of the text: "Recent researches 
into so-called 'subconsciousness' as involving mental processes 
which go on 'below the threshold,' and theories of double and 
triple selves have served further to confuse or discredit the time- 
honored concept of a soul, or mind, as a permanent and quasi- 
independent entity. It would be aside from the course of our 
inquiries to consider these objections in detail at this time." 
One cannot help wondering why it "would be aside from the course 
of the inquiries," since the book aims otherwise at completeness 
in the discussion of mind. One wonders how long so many of the 
unmedical psychologists will retain their prejudice against a 
normal group of basal phenomena simply because the average 
subject in the college psychologic laboratories does not wear them 
diurnally on his sleeve. Is not the normal mind as one sees it in 
the nerve-clinics, then, as human, as good material, and withal 
as instructive, as enlightening, as are those aspects of the mind 
so much studied in the college laboratories.^ And surely one 
wonders why Professor Ladd (for it does not sound like Professor 
Woodworth) sees fit to pronounce that researches into sub- 
consciousness and theories of double and triple personality "have 
served further to confuse or discredit the time-honored concept 
of a soul, or mind, as a permanent and quasi-independent entity." 

147 



148 The Journal of Abnormal Psychology 

On the contrary, to the present reviewer for one, at least (and possi- 
bly to some others?) these very researches and theories have 
helped like nothing whatever else to explain and to clarify the 
inherent personality of man in his relations both to the individual 
organism and to the eternal verities and values around him here 
and hereafter. Dominant in this matter, of course, is one's 
metaphysic, one's philosophy — dualistic or monistic — only a 
point of view, a matter of definition or of temperament. But as 
we come by way of physical science to comprehend matter in 
terms of mind perhaps we shall learn to understand mind in 
terms of matter — the soul in its bodily relationships, and there- 
fore all the more soul. 

But even leaving out the important matter of the sub- 
conscious aspects and their relations to neurilityon the one hand and 
to cleai "pure" consciousness on the other, this treatise on the 
bodily aspects of mind is elaborate and replete with the informa- 
tion every devotee of psychology needs, be he amateur or pro- 
fessional, student or physician. The illustrations are both many 
and to the point. The references to collateral literature are very 
numerous; there is an index of authors at the end of the volume 
that would be more useful and less misleading were the initials 
of the writers given. 

One of the best chapters in the book is that on feeling, emotion 
and expressive movements. It is complete and unbiased. The 
discussion of cerebral localization, too, while leaning perhaps 
unduly to the Ferrier side, is, on the whole, safe and sane, as is 
fitting for a text-book, which should give the details of whatever 
localization has been reasonably suggested. One certainly misses 
Bastian's viewpoint in the book as an explicit doctrine, especially 
since recent advances (such, for example, as the work of Mac- 
Dougall, Head and Holmes, etc.) make for a much broader phras- 
ing of the new phrenology of Ferrier, etc., in terms of a totally 
psychomotor great brain, a motor spinal cord, and a mediating 
cerebellum and brain-stem. One sees from this complete and 
connected description and discussion, and usually better than 
from the compendious Lewandowsky or von Bechterew, how 
completely advance in psychophysiology is blocked until the 
appointed genius shall discover the recondite secret of the action* 
of the brain. It cannot come through "localization" we may 
more and more confidently assume, but it will come, sometime, 
when occurs the right revealing combination of insight and of 
understanding of the integrated neural plan. Such books as this 
of Ladd and Woodworth will help to this great end better than 



Reviews 149 

anything else — save the genius the neurologic world awaits. 
The book is undoubtedly the best of its kind in the market. 

George V. N. Dearborn. 
Tufts Medical and Dental Schools. 



THE CONQUEST OF NERVES. By J. W. Courtuey, M. D., 
The Macmillan Co., New York, 1911. Pp. 209. 

A SOMEWHAT nice discrimination is demanded of the author 
who would write medical books for popular perusal. On the one 
hand he must avoid vague, and therefore useless, generalities; 
on the other, too great minuteness of detail. This difficult task 
of walking in the middle pathway has been accomplished with 
conspicuous success by Dr. Courtney, in his pleasing and instruc- 
tive little volume, "The Conquest of Nerves." At the present 
time we are engaged upon the conquest of most everything, so 
perhaps it is quite fitting that we should include in our program 
the conquest of our nerves, which is the twentieth-century way of 
saying, the conquest of ourselves. It is a very ancient business, 
this of conquering ourselves. But the particular nerves or 
selves we have to conquer are not always the same; they differ 
with times and places, and hence we are ever in need of new in- 
structions to assist us in meeting changed conditions. Here, as 
elsewhere, knowledge is the prerequisite of power; and much 
knowledge that the layman ought to assimilate and use is to be 
found, clothed in graceful English, in this little book, which can be 
read leisurely in the space of an evening. 

There are ten chapters, among which we may note the fol- 
lowing: How Christian Science Cures, The Emmanuel Movement 
and Its Doctrine of Health, New Thought or the Psychotherapy 
of Optimism, The Nature and Causes of Functional Nervous 
Disorder, The Physical Treatment of Functional Nervous Dis- 
order, The Psychotherapy of Functional Nervous Disorder. 
Very timely topics surely, most interestingly discussed. 

For Dr. Courtney, as for all who have thought seriously 
about the matter, the highest privilege, as well as the most urgent 
duty of the physician, in the face of functional nervous disorder, 
is to become a teacher, — one who will attempt, with whatever 
success, to make straight some of the crooked mental and emo- 
tional ways of neurotic people. Too often, when treating nervous 
patients, we physicians have taken our academic degrees literally, 
- — we have been content to be doctors of medicine, and so have 
failed to take advantage of our higher opportunities as doctors of 



150 The Journal of Abnormal Psychology 

men. Let no one be over-harsh with us for this, because, after all, 
life is short, and nervous people consume an enormous amount of 
time. But now, in our necessity, comes Dr. Courtney to our 
assistance, with just the kind of exhortations and explanations 
which we are anxious to give to many patients under our care. 
Armed with this little book and fortified by the personal advice 
and direction of his physician, the nervous sufferer will find, we 
make bold to say, his burden growing lighter and his emancipation 
ever more near and certain. He will learn that the basis of his 
cure is self-help; for this is the theme that Dr. Courtney variously 
develops throughout his book. The methods whereby the 
patient can help himself are clearly set forth, and range all the 
way from the swallowing of raw eggs to the making of collections 
of all kinds, the study of languages, painting, music, and the 
different weaves of Oriental rugs. About all of these matters there 
are helpful hints and useful suggestions, sprinkled here and there 
with a dash of humor. 

We do not agree with everything Dr. Courtney says; he 
doesn't expect that we should. But concerning the essential 
reasonableness ^nd truth of his main contentions, there can be but 
one opinion. We bespeak for his little book a cordial reading by 
those for whom it was written. John E. Donley, Jr. 



STAMMERING AND ITS PERMANENT CURE. By Alfred Appelt. 

pp. 234. London, 191L Methuen & Co., Ltd. 

The recent applications of psycho-analytic methods to the 
treatment of stammering have been attempts to demonstrate 
that this speech disturbance is one of the protean forms of an 
anxiety neurosis and not merely a tic or a spastic neurosis of co- 
ordination originating in childhood on a strong hereditary basis. 
All who have observed and treated cases of stammering have 
been impressed by one significant fact, namely, that in the large 
majority of cases the child does not begin to stammer until he has 
been talking freely and normally for several year,s. What then 
is the cause of this disturbance of speech.^ How and why does it 
arise out of the normal, co-ordinative speech mechanism.^ The 
few cases of stammering reported as having been treated and cured 
by the psycho-analytic method have led to the belief that the dis- 
turbing mechanism must lie far deeper than a mere inco-ordination 
of the muscular apparatus of speech. It is a significant fact that 
all stammerers show a dread of speaking with a feeling of inhibi- 
tion, and that these psychic accompaniments of stammering can 
frequently be overcome by hypnosis. It is into an enquiry of 



Reviews 151 

these problems that Appelt has devoted an interesting and an 
illuminating volume. Even if one fails to fully agree with the 
author's theories and conclusions, he will find here much inter- 
esting material. 

The author begins with a history of the various theories of 
stammering and from this he passes to an account of the mechan- 
ism of speech and the pathology of its various disturbances. He 
believes that heredity, neurotic disposition and wilful imitation 
have in the past been too largely incriminated as causes of stam- 
mering, and that, therefore, one must not be satisfied with such 
superficial explanations. By means of the lengthened association 
time in cases of stammering, he demonstrates that we are dealing 
with a form of morbid anxiety due to unconscious emotional 
complexes. For instance, he states: "The act of repression, 
though a normal psychic process, can, owing to the predominance 
of the unconscious, easily meet with ill success, inasmuch as the 
repressed impulses continue to exist in the unconscious and are 
liable to send a disguised substitute into consciousness, stammer- 
ing or any other neurotic symptom. . . . When treating stam- 
mering, for example, it can invariably be found that the emotion 
(dread of speaking) connected with the infliction is due to stimuli 
which are contained in the impressions of the unconscious only, 
and he who undertakes to free stammerers of those tantalizing 
emotions must needs know how to analyze their unconscious." 

Therefore, since stammering is due to these unconscious in- 
fluences, he believes that the proper treatment must be purely 
psychological, as it is useless to attempt to teach the sufferer hozu 
to speak, because under certain circumstances stammerers ex- 
perience no difficulty in speaking. In the treatment of stammer- 
ing, the author has but little faith in either physiological methods 
of speech training or in direct suggestion to overcome the fear of 
speaking. The proper method is to remove the deeply rooted 
dread or anxiety from the unconscious, and this, according to the 
author, can be accomplished only through psycho-analysis. 
Since stammering is a pure psycho-neurosis, in fact, a type of 
anxiety neurosis, the baneful influence of the unconscious com- 
plexes upon speech must be removed during the process of the 
treatment. A large portion of the book is devoted to an exposi- 
tion of the Freudian psychology and its application to the problem 
of stammering. No clinical details of analyzed and treated cases 
are given. It seems a pity that these were omitted, as the value 
of the book would have been greatly enhanced by the inclusion 
of such data. j_ ^_ ^oriat. 



152 The Journal of Abnormal Psychology 

LA DEPERSONNALiSATiON. PuT L. Dugus and F. Moutiet, 
Paris. F. Alcan, 1911, 223 pages. 

Dissociation of self occurs in numerous forms. It is in- 
volved in abstraction and in contemplative thought of any kind. 
Depersonalization, as the French writers call this condition, is also 
involved in those states in which the subjects perceive the world 
as distant and hazy, as if seen through a veil. There are thus a 
number of disparate states, possessing more of analogy than simili- 
tude between them to which this term has been applied. For 
this reason it is not easy to define the term or even to describe the 
meaning of depersonalization. 

These two authors, one skilled in clinical, the other in mental 
tests, begin their study of the condition by pointing out that, like 
any other manifestly morbid process, dissociation of personality 
passes only by imperceptible gradations from the normal over into 
the pathological, so that no clear line of demarcation can be drawn 
between the two. All factors conducive to asthenia, sadness, and 
disease, uncertainty and, in a measure, mental disorientation and 
violent contrasts predispose to the loss of personality, although 
why this state should be brought about in some cases and not in 
others, the authors are unable to explain. 

It is interesting to note that the authors camp upon psycho- 
analytical ground, as when they recognize, for instance, that in its 
simplest form, depersonalization is largely a phenomenon of de- 
fense, brought about by the efforts to neutralize the consequences 
of a violent algedonic emotion. The self becomes dissolved in 
order not to suffer unduly. The process is, in short, a form of 
transient suicide. One is, of course, reminded of Freud's "flight 
into psychosis" by this explanation. 

If the "flight" is prolonged, the dissociation of the feeling of 
self persists and expresses itself in an advanced form of mental 
disintegration. Any reader might follow the authors thus far 
without being ready to admit with them that abuse of introspec- 
tion and metaphysical speculations or long-continued brooding 
over the meaning of self may bring about dissociation of per- 
sonality. On what grounds could such a contention be justified 
at present.^ To be sure, subjects frequently do show a morbid 
inclination to introspect, but may they not be driven to it by a 
peculiar derangement of organic sensations.^ In other words, 
may not brooding and morbid introspection be the result and 
not the cause of the condition.? If a choice were at all pos- 
sible at the present stage of our knowledge, it seems to the re- 
viewer that the latter would be a more reasonable contention 
than the author's. 



Reviews 153 

The road which leads these authors to their contention is no 
doubt paved by their peculiar view concerning the psychogenic 
mechanism of dissociation. It is, in fact, the only view they can 
take of the role of morbid introspection in the disintegration of 
personality because of their view that the latter trouble is of apper- 
ceptive rather than sensorial order. They maintain that the 
trouble in dissociated personality is not with the subject's sensa- 
tions, but lies in the higher mental faculties. To justify this posi- 
tion, the authors state that in their examinations the sensory 
organs of patients revealed nothing abnormal. This is not con- 
clusive; our ordinary means of sensorial analysis are too crude 
to be decisive in so important a matter as this. It would require a 
long series of carefully worked out estimates of patients' sensorium 
by the use of the most accurate instruments which laboratory 
technique affords before one would be in the possession of sufficient 
data for any generalizations. Cursory clinical examinations 
and tests are inadequate for such a task. What is more, even 
the highest degree of laboratory precision may be insufficient at 
present. Other, more delicate, means for sensorial analysis may 
have to be devised before we may be certain of the actual 
facts. Suppose, for instance, that but a very slight degree of 
sensorial oscillation away from the "average" is sufficient to 
bring about the loss of the feeling of self; it would also require very 
accurate measurements and the highest skill in laboratory technique 
to discover the variation, — perhaps a task beyond our present 
means altogether. At any rate, ordinary clinical tests, such as 
the authors have used, are insufficient. At best our present 
means of sensorial analysis are rough, and suitable, primarily, 
for the "normal" subject; the psychopathologist has borrowed 
them from the laboratory of the experimental psychologist, where 
they may answer ordinary purposes. So far as the reviewer is 
aware the psychopathological laboratory has not yet devised a 
scheme of sensorial analysis of its own so accurate that it might 
enable us to note the subtle irregularities which escape notice in 
the rougher analyses of the normal subject. Moreover, psycho- 
pathological studies along this line have only begun; thus far the 
results of sensorial analyses of such patients appear to weigh 
decidedly against the contention of Dugas and Moutier. In other 
words, the weight of evidence seems to be that sensorial disturb- 
ances are, as a rule, present in dissociation. 

The authors themselves describe, without explaining, a 
peculiar state of indifference which they have noticed in their 
patients; this, too, points strongly to some derangement of or- 
ganic sensations. What else shall we make out of the anesthetic 



154 The Journal of Abnormal Psychology 

states of these patients, for Instance, already observed by Ribot? 
Or of the patient's complaint "I am of marble"? Or of another 
patient's assertion, in the experience of Dr. Prince, that she has 
lost her body sense, that her hand seems not to be hers? 

Indeed, the suspicion of a sensorial disturbance is more than 
justified, while the present authors' contention is not. Before we 
have recourse to the apperceptive functions for an explanation of 
the troubles of dissociation we should inquire more closely into 
the perception sphere of these patients. Our perceptions are 
schematic, anyway. As we approach higher mentality the sen- 
sorial elements are reduced to a minimum. This is a simple and 
well-known fact. In the ordinary course of experience it is only 
necessary to take in or perceive a few of the most characteristic 
features of a scene to see the whole, just as the habitual reader 
takes in only a few letters to read the whole line. Were it not for 
this habit of the mind, proofreading would be less troublesome. It 
is in accord with the economizing tendency of our psychic activity 
that the sensorial elements in an act of habitual attention are re- 
duced to a minimum. At the same time it is only proper to con- 
ceive that a threshold of schematization must be reached, espe- 
cially in the case of new impressions, beyond which the sensorial 
elements are no longer sufficient for the reconstruction in terms of 
mental imagery of an object observed, or of some scene witnessed. 
The real problem seems to be: Does the subject pass beyond this 
threshold of schematization of sensorial elements when disso- 
ciation of personality takes place? It would be interesting, in this 
connection, to examine the subject's range of imagery, which would 
represent, of course, the material intermediate between sensation 
and perception. A methodical examination of this kind would 
furnish valuable data. Here there lies open a field for research 
rich in promise. 

But to return to our authors. On the question of memory 
in connection with dissociation, they are far from clear. It ap- 
pears, for instance, that they do not distinguish sufficiently 
memory from imagination. The two processes are treated almost 
as if they were identical. The same carelessness is noticeable on 
the subject of the relations between memory and the logical proc- 
esses. One example might suflftce; on page 49 occurs the follow- 
ing statement: "The facts forgotten by Mme. A. were such that 
simple reasoning should have been sufficient for their recall; 
and being of a methodical and reflective turn, Mme. A. recalled 
them easily enough, without, however, recognizing them." 

This is rather unreliable psychology. In what sense is that a 
memory at all which we do not recognize? Besides past images 



Reviews ^ 155 

are recalled through association and not through reasoning. This 
patient's complaint that she can no longer add her new sensations 
to her old self is a bit of information which should have been seized 
upon by the authors. It comes nearer the core of the trouble 
which results in dissociation than the authors' contention that 
the patient's sensations undergo no change. 

A word about the authors' general conclusions: They trace 
dissociation to "a derangement of psychic functions, in which 
. . . subjective states become detached from self," "se deroulent 
en dehors de lui," or in which "le moi les laisse echapper de sa 
pensee devenue indiiferente." (P. 121.) The statement, while 
true, seems too vague. 

J. S. Van Teslaar. 



LA DEMENCE PRECOCE; ETUDE PSYCHOLOGIQUE MEDICALE ET 

MEDicoLEGALE. Par Dr. Constanza Pascale. Paris. F. Alcan, 
1911, 302 pages. 

This medico-psychological study of dementia praecox reminds 
one that the old sectionalism has not been overcome com- 
pletely as yet, notwithstanding the international and cosmopolitan 
character of the science. Thus Dr. Pascal's work is based upon 
material derived chiefly from French sources, notably the works of 
Dromard, Dide, Masselon, Regis, Seglas, Serieux, so that for the 
extremely important work done elsewhere on this subject one 
must consult other sources of information. In other words. Dr. 
Pascal's work is not a complete survey of the subject with which 
it is concerned. Considering its size, perhaps this work was not 
meant to reflect the present state of knowledge on the problem of 
dementia praecox, but rather to give its author an opportunity to 
record, in a personal way, the views and conclusions to which her 
hospital experience with this condition have led her. It is in- 
contestable that works of such character have a certain merit of 
their own, even if they do not add materially to our knowledge of 
the problem as a whole. 

For clinical purposes psychic activity may be looked upon 
from three broad aspects: affectivity, intelligence, and volition. 
Accordingly, the author discusses dementia praecox from each of 
these standpoints. She attempts to delineate sharply the meaning 
of such terms as mental, intellectual, and demential weakness, 
respectively; there is at present a great deal of confusion in the use 
of these terms. After pointing out some reasons for distinguishing 
between these terms which should help in their proper use the 



1 56 The Journal of Abnormal Psychology 

author turns to a consideration of the morbid condition proper, 
following its development from the milder to the more grave 
forms. 

The characteristic psychic lesion of dementia prsecox consists 
of a deep and peculiar disturbance of the subject's affectivity. 
As a consequence of this condition the energy tonus of the funda- 
mental algedonic and heuristic affects is weakened; pleasurable 
sensations become blurred; they blend readily with their opposites 
the sense of demarcation between them being on the wane. There 
is a disturbance of self-feeling and of the subject's sphere of emo- 
tions. In the author's own words, the trouble is due to " dis- 
organization of the affective range of vital forces, a destruction of 
sympathy and of the feeling of personality, a reduction in the con- 
sciousness of self." 

In the realm of the intellect, absent-mindedness is character- 
istic. During this impairment of adaptation to surroundings the 
spontaneous attention of Ribot is the first to become disturbed. 
Soon the psychic function of systematization breaks down, as is 
shown by the association tests, and this early inco-ordination leads 
to serious incoherence of ideas. 

The catatonic, hebephrenic and paranoidal forms of the 
disease are varieties of the same fundamental condition; the char- 
acteristic feature of which is a more or less rapid dissolution of the 
feeling of self and a corresponding increase in automatic activity. 
The different clinical forms of dementia prsecox are characterized 
alike by the demential character of the delirium and the great dis- 
proportion between the latter and the intensity of the affective 
tonus. Their common basis is also shown by the histo-patho- 
logical findings. Post-mortem examination in any of the three 
forms usually reveals a chronic diffuse neuro-epithelial inflamma- 
tion as the anatomic basis of the disorder. 

The author distinguishes three clinical stages in the course 
of the disease: The prodromal stage may mask itself under any of 
the more common ailments of nervous order; it is frequently mis- 
taken for neurasthenia. The active period is the one during which 
the disturbance of the subject's affectivity is highest; this stage is 
complicated by impairment of the will, delirium, and stereotypies. 
Finally, the residual or permanent period may be light, medium, or 
advanced. 

Brief mention is made of such affections of the psychomotor 
mechanism as aboulias, dyspraxias, automatic acts, glossopathias, 
and of the troubles of memory, imagination, and recall, frequently 
encountered. Many of the latter are due to the patient's inability 
to center his attention. 



Reviews 157 

The author devotes special attention to the medico-legal 
aspects of the subject. Patients of this class are especially numer- 
ous not only in the prisons for adults, but in the various institutions 
for defective and criminal children as well. In the school such 
subjects are often punished for stubbornness, and in the army for 
insubordination. She thinks that dementia praecox is specially 
common in the German army. 

It is not always easy to distinguish genuine cases of dementia 
praecox from simulation. Frequently, a genuine case is compli- 
cated by an attempt at simulation, thus increasing the diagnostic 
difficulties as well as the responsibility of experts. 

Perhaps the least satisfactory portion of the work is that 
devoted to the discussion of treatment. This is no particular 
fault of the author's, as the chapter in question merely reflects 
in general lines, the actual state of our therapeutic knowledge, with 
the exception, of course, of what light has been thrown upon the 
subject of treatment by our German colleagues. As has been 
mentioned, the author has received practically no inspiration from 
German sources, in the preparation of the present work, so that 
what knowledge comes from that direction is not disclosed to the 
readers of the present treatise. The consequence is that one misses 
the suggestive, confident, and highly inspiring note which greets 
the reader of modern German works in this subject. We are 
told, for instance, that "curative" treatment "is being studied." 
This, as every medical man is aware, is the text-book writer's usual 
way of gliding over an unsatisfactory subject. Concerning the 
paliative plan, more dignifiedly called "symptomatic" treat- 
ment, we receive the information that occasionally it may sur- 
prise us by actually yielding results; finally, we are told that much 
may be expected in the future from the preventive plan. 

Dr. Pascal remarks very properly that the hygiene and pro- 
phylaxis of dementia praecox blend imperceptibly into school life 
hygiene, and the hygiene of adolescence in general. While she 
thus approaches Freudian ground, she has no such clear-cut con- 
ception of prophylactic measures as the psychoanalytical view- 
point affords. Her prophylactic recommendation, for instance, 
that all "predisposed" children between the ages of fifteen and 
twenty years should be made to abandon all intellectual pursuits 
and devote themselves to a non-fatiguing course of physical train- 
ing, is too vague, because it does not refer directly to a particular 
source of trouble to be of much value. It cannot even be said 
that this is the best kind of advice for all cases. As to moral 
education and so-called training of the will, they are preconised by 
the author, but in such a general and vague sense that her advo- 



158 The Journal of Abnormal Psychology 

cacy of these prophylactic measures amounts largely to a fortui- 
tous platitude. Indeed, there is no lack in our midst of "be- 
lievers in" strict "moral" training for children. But observe also 
that information on all sexual matters is kept away from the 
children's minds nowadays with much disastrous results to many 
of them, and to society in general precisely, on "moral" grounds. 
Evidently, it is not sufficient to "believe in" moral education and 
training of the will to accomplish results. The author strikes 
much nearer the root of the evil when she recommends the proper 
training of children in sexual matters. This is the more commen- 
dable on her part, as her appreciation of the psychogenic role of 
sex in dementia prsecox, though strongly manifest, is of a most 
general order, it not being based upon such knowledge as those 
familiar with Freudian literature, for instance, possess. The latter 
will agree with the author that henceforth the periods of adolescence 
must occupy the attention of physicians, educators, and psychol- 
ogists. Notonly do students of psychoanalytical literature appre- 
ciate that the skill of all these three classes of experts must be 
combined to help the youth, as the advocates, but what is more, 
they learn to look upon infancy as an equally critical period of 
psychic storms and stresses, a fact which thus far seems to have 
escaped Dr. Pascal's attention. 

J. S. Van Teslaar. 



DIE PSYCHONEUROSEN, NEURASTHENIE, HYSTERIE UND PSY- 

CH'ASTHENiE. Ein Lchrbuch fur Studierende und Aerzte. Von 
Dr. Otto Dornbluth. Leipzig. Verlagvon Veit u. Co., 1911, 700 
pages. 

This work, the general subdivision of which is indicated in its 
subtitle, is intended, as is also shown on its title page, for students 
and practitioners, and is, without doubt, a fairly complete didactic 
survey of the subject. The etiology, clinical course, diagnosis and 
prophylaxis of the psychoneuroses are very satisfactorily covered 
from the prospective student's standpoint. On the whole, the 
teachings incorporated in this work are just what would be ex- 
pected, though occasionally the author's "personal equation" 
makes itself felt. This is particularly true of the last portion of 
the work, devoted to treatment, to which we therefore turn our 
attention. 

The first thing that attracts one's attention in the section 
devoted to treatment, is the discussion of psychoanalysis. Incor- 
porated as part of text-book teaching, it can no longer be maintained 



Reviews 159 

that psychoanalysis is a current somewhat marginal to the main 
stream of psychiatric thought. Nor can it be said that the pres- 
ent work is by a pupil of Freud's. On the contrary, Dornbliith looks 
upon psychoanalysis rather skeptically while appraising its thera- 
peutic value, though it must be said that in other respects this 
author's disposition is, on the whole, rather favorable to the new 
movement. His discussion of psychoanalysis, though brief, is fair. 

Psychoanalysis is a serious and momentous procedure; the 
author compares it to a capital operation upon the body; it is a 
spiritual operation of equally serious import, and, as in the case of 
the former, he is of the opinion that the physician who recom- 
mends this plan of treatment is under the moral obligation to 
warn beforehand the patient and all others concerned about the 
method and aims of the plan. As in the case of a major surgical 
operation, it is for the consultant to determine whether the plan 
is applicable in a given case. 

It is sometimes maintained, and the present author repeats 
with apparent approval, that much of what is regarded as the 
direct result of psychoanalysis admits of a "more direct" inter- 
pretation. 

We are told by this author that there are a number of things 
hidden which are not at all situated in the subconscious, a knowl- 
edge of which the physician may acquire without any hindrance or 
opposition, if he only obtain the patient's confidence. No student 
of psychoanalysis ever believed otherwise. But how does this 
invalidate a single claim of the psychoanalytical school.^ The 
real question is: Does the unearthing of consciously hidden secrets, 
in short, the ordinary confessional method, result in the therapeutic 
benefit which follows the unearthing of the pathogenic complexes 
out of the subconscious spheres.^ The man who, like Hellpach, 
compares the psychoanalytical course with the confessional should 
bear in mind that analogies are dangerous because of the tendency 
they create of falling into meaningless, because unreal, literalism. 
He who thinks that psychoanalysis means no more than the bring- 
ing of the confessional into the consulting room should rid himself 
of the error by learning to know what psychoanalysis really means. 

Dornbliith asserts, we know not on what basis, that many 
cures ascribed to psychoanalysis are in reality cases of spontaneous 
healing. At the outset this could be granted; in a certain sense 
all cases heal spontaneously. The Freudians, perhaps more than 
any other class of investigators in the field, have striven to 
show that every new symptom arising in a psychopathic case 
represents a tendency towards cure. They interpret the whole 
clinical picture as an eflfort to readjustment. 



160 The Journal of Abnormal Psychology 

The author believes further that the systematic use of other 
therapeutic means would result in cure so that the uncovering of 
the etiological factor in the psychoanalytical sense may be super- 
fluous. What is required in the first place is the regulation of the 
patient's plan of living, especially of the patient's affectivity in 
such a way as to counteract the influence of the morbid complex. 

The increasing prevalence of psychoneuroses is looked upon 
by the author as the psycho-physical expression of the growing 
morbid affectivity incidental to modern life. A great deal can 
be accomplished in the case of the simpler forms of nervous in- 
stability by expert advice and systematic psychic re-education; 
in many cases this is all that may be needed. Even in the more 
difficult neuroses such a course prepares the ground for and facili- 
tates whatever additional treatment might be advisable. The 
chief task is to train such patients to appreciate the role of affec- 
tivity. As it is not possible to protect patients from undue ex- 
citements and effective outbreaks, it is necessary to fortify them 
against such occurrences, so that they may withstand them better. 

The frequent declaration of patients that their nervous trouble 
dates from a particular critical experience must be looked upor 
with suspicion. Accidents and psychic shocks like those to whicK 
patients frequently trace back their condition, may be responsible 
for some light or transient form of melancholia, but the more grave 
forms of neurasthenia and hysteria must be due to a much deeper 
trauma, a more or less permanent disturbance of affects requiring 
readjustment. 

Unsatisfactory marriage relations are looked upon by the 
author as the most common cause of psychoneuroses. Women 
bear the consequence more commonly than men because man dis- 
charges his affects through his vocational activity, while woman's 
sphere is much more limited and affords less opportunity for 
sublimation. 

Great stress is laid by the author upon the psychic influence 
for good of the family physician. He deplores the fact that as 
yet medical schools do not impart suflRcient instruction about the 
more important psychoneuroses so that general practitioners must 
invariably turn such cases to the specialist. He sees good in and 
approves other methods than psychotherapy, though he iS' in- 
clined to think that the success of most plans of treatment, in- 
cluding dietetics, is due in great part to their educative and psychic 
effect rather than to any inherent qualities of their own. 

J. S. Van Teslaar. 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



AUGUST-SEPTEMBER, 1912 



INTERPRETATION OF ''PROFESSIONAL-CRAMP- 
NEUROSIS'' AS A TIC 

BY TOM A. WILLIAMS, M.D., M.B.C.M. (eDIN.) 

Corresponding Member Paris Neurological Society, Psycho- 
logical Society, etc., Neurologist to. Epiphany 
Dispensary, JVashington, D. C. 

THE psychological mechanism of the muscular cramps 
produced during the attempt to perform the acts 
of a very ordinary occupation is so complex that its 
consideration has been passed over both by Janet 
(2), and Meige (1), each of whom, however, has pointed out 
the resemblance of occupation-cramp-neuroses to true tic. 
To these authors they differ, however, from the tics in being 
a disorder of a different normal act, whereas a tic is more 
in the nature of a new, acquired act, irrespective of a pre- 
viously acquired automatism. The tic is, in the first place, 
deliberate and volitional from beginning to end. The 
occupation-cramp is only a modification of an act, once 
deliberate and volitional, which has become automatic, as 
far as any action under constant control of the neopallium 
can be so considered. But both tic and occupation-cramp 
may be summed up as acquired functional automatisms of 
pathological nature. Meige has made it a fundamental dis- 
tinction that "occupation-cramp appears exclusively during 
the exercise of the function which it concerns, while the tics 
are generally aroused into activity by anything or nothing." 
But has one a right to postulate the origin of each tic 
movement from nothing.? We know, on the contrary, from 

^A portion of a communication presented in abstract to American Psycho- 
pathological Assoc, Baltimore, 1911. 

161 



162 Interpretation of '^ Prof essional-Cr amp-Neurosis^"^ 

the work of Brissaud and his followers, of whom Melge is 
not the least, and of Janet, that it is an idea which deter- 
mines the cortical stimulus producing a tic; in which respect, 
tic does not differ from the teleological acts of everyday life. 
Now, this idea may be aroused in many different ways, as 
can the act-determining ideas of daily life. But although 
caused in different ways, is not the final act-determining 
idea always the same for the same tic in the same person? 
For example, the- determinant of the idea which produces a 
tic of sucking and cheek-biting is the peripheral stimulus 
from the discomfort of the mucous membrane, which has 
become a besetment. The clonic torticollis tic is derived from 
the idea of seeking greater comfort by previously experienced 
readjustment of the position of the neck through the altered 
tension of its muscles. A blinking tic, again, arises from an 
idea, viz., that discomfort will be diminished through com- 
pression of the eyeball by the orbicularis palpebrarum. 

It is true that the causal idea is not manifest in the 
ultimate stages of the tic's evolution; for the act has become 
an automatic one. In this respect, however, it does not 
differ from many complicated professional acts, such as 
piano-playing, which is undeniably a product of volition. 
The comparison might be carried further; and the striking 
of a particular note of the piano in a particular way may be 
compared with any selected component movement of a tic. 
Only a definite stimulus, and always the same for the same 
piano played, will cause the striking of the same note in the 
same way.^ 

The case of E. L.^ illustrates most forcibly how one 

^Of course the psychophysiological constellation which arouses the cor- 
tical activity leading to the piano-player's act may have several components, 
only one or more of which need be stimulated in the first place. Thus, the player 
may strike the note (1) upon sight of its symbol printed on the staff; (2) upon 
memory of its sound irrespective of symbolical representation; (3) as a consequence 
of the kinesthetic impressions remembered from a previous performance; and there 
are other possibilities. It need not be elaborated that any of these, singly or in 
combination, may, in accordance with the associational make-up of the player, 
eventuate in the same note played in exactly the same way. If the constellation, 
however, is not firmly associated, a different tone may be the fruit of different 
combinations of the stimuli causing the playing of the note. 

'^Studies of occupational cramps of writers and telegraphers. Jour. f. Psychol, 
u. Neurol, (von Brodman), Leipzig, 1912, Bd. 19, pp. 88-112. 



Tom A. Williams 163 

Idea produced at the same time both an occupation-cramp 
and a tic. It shows too that the law of Meige regarding the 
exclusive appearance of occupation-cramp during the func- 
tion it concerns is by no means rigid, and that the anomaly 
of movement may occur during other acts as this disorder 
progresses. The case of Llt.^ illustrates this in a less de- 
gree; for at times her inability to write extends to both 
certain kinds of sewing and the handling of heavy crockery. 
In the case of F. S./ too, there is also sometimes a difficulty 
in sewing; and her idea of incapacity has now and then ex- 
tended to many actions performed with the right arm; so 
that it was very difficult to convince her of the absence of 
disease of the muscles or joints, as also concerning her voice. 
Thus, it is not possible to lay down as Meige has done (pp. 72 
and 192) a law separating tic and scriveners' palsy. For 
when the psychological mechanism is considered, and 
analysis is pushed deeper than has been done either by 
Meige or Janet, the pathogenesis is found to be essentially 
the same. 

The Tics. — This is not the place to enter into a dis- 
cussion of the various dyskineses or myoclonias. A few 
words, however, must be said of habitual gestures and atti- 
tudes and of the true tics. The former occur in perfectly 
normal Individuals as well as In the insane, In whom they 
are called stereotypies. Examples In the normal are strok- 
ing of the mustache, wrinkling of the brow, whistling, 
playing with the watchchain, grimacing of the face, waving 
the hand, or sawing the air while speaking. So long as these 
are unconscious automatisms, and so long as they could 
be prevented without suffering by a little care on the part 
of the performer, they do not merit the name of habit spasm, 
nor can they be classed with the tics. 

The latter are convulsive and intemperate In character, 
are accompanied by a consciousness of the act, are preceded 
by a desire, sometimes amounting to a passion, to perform 
the act, and are followed by a feeling of relief after per- 
formance of the movement. At all events the victim of tics 
feels compelled to make the movements comprising the tic. 

* Studies of occupational cramps of writers and telegraphers. Jour. f. Psychol. 
U.Neurol, (von Brodman), Leipzig, 1912, Bd. 19, pp. 88-112. 



164 Interpretation of ^^ Professional-Cramp-Neurosis ^^ 

The movements always represent, however incompletely, 
some voluntary act, e. g., turning the head, shrugging the 
shoulders, biting the cheek, winking the eye, sniffing, etc. 
The end to which the movement was first directed has, 
however, often passed from the recollection of the patient; 
and the act itself has often degenerated into a caricature of 
what it originally was. A simple example is a winking of 
the eyes which has continued for years in spite of the fact 
that the irritation of the foreign body which first excited 
it has long subsided. It often originates in an idea which, 
however, ultimately becomes ignored or forgotten by the 
patient, such as in the case of E. L. 

Nor is this the place to discuss the forms of tic; suffice 
it to say, that in hypersuggestible individuals, tics are 
easily induced sometimes, make little impression upon the 
patient, and are very simply removed by re-education and 
persuasion or even by suggestion. These we call hysterical.^ 

The tic, on the other hand, which is preceded by an 
imperative longing, the struggle against which causes in- 
tense suffering, occurs in over-scrupulous individuals of 
little suggestibility, whom Janet has called psychasthenics, 
and who show numerous stigmata of their constitution in 
addition to the tic for which they may seek advice. Both 
E. L. and F. S. are of this type to some extent. 

The principles of treatment of the tics, as laid down by 
Brissaud and developed by Meige, are entirely similar to 
those which have proved successful in the cases of profes- 
sional cramp here presented. 

! A tic must be distinguished from a true spasm, which 
is due to direct physical agency. The latter is entirely 
beyond voluntary or emotional centers, and hence insus- 
ceptible of psychotherapeusis. 

^That fact, by an intelligent being, needs interpretation. The obvious 
one is that of physical disease. This ready explanation is corroborated 
by medical opinion and procedures. Part of our treatment is the getting rid 
of the reinforcement derived from injudicious advice and measures; for if not, 
every attempt to write at once arouses the fearfulness for a damaged member or 
nervous mechanism. Again, pernicious habit-attitudes have to be fought. This, 
however, is best done indirectly through a planned orthopoedics, directed 
towards a new automatism, gained, as was in childhood, the old one. 



Tom A. Williams 165 

The Genesis of Occupational Cramps. — The dis- 
ability may be, at its first occurrence, accidental, as from 
fatigue or stressful effort. But the fact of failure soon 
creates the fear of future failure. Hence, whenever the 
act is attempted, fear interferes with harmonious automa- 
tism. It is the efforts to overcome this which cause and per- 
petuate the cramp. 

This ideogenetic affect becomes then constantly linked 
with the inception of the fact, and becomes part of the syn- 
drome, although it is not primitive. To attack the affect 
directly is useless; for by however hopeful an attitude it 
may be destroyed, the disability of the act persists. If, 
however, the anxiety-affect disappears as a consequence of 
the removal of its source, the idea which originated the cramp 
in the first place, then it remains constantly absent, and a 
cure may be effected; which does not occur when only a 
consequence, the affect, is aimed at, even successfully. 

The principle is the same as that laid down concerning the 
traumatic neurosis and hysteria in general, Mn which removalof 
an affect is only more than evanescently curative when at the 
same time, intentionally or not, the genetic idea is itself re- 
moved concurrently, that is to say, when the patient is re- 
educated by the removal of his false belief ac to disability. 

Not that he himself is usually capable, however well 
intentioned, of abolishing his error; for although such cases 
of instantaneous conversion do occur, it is the rule for a con- 
siderable time to be required for penetration of the new men- 
tal attitude sufficiently effectively to influence conduct. 
A passive acquiescence has no dynamic effect; and cases 
which assent readily do so only because they have not 
realized the significance and bearing of the truthful idea; 
indeed when they are forced to analyze their thoughts, it is 
found that they have not comprehended what the physician 
has tried to convey. 

Their state is acceptance and not conviction. The 
latter connotes conflict; and that is usually neither ready 
nor speedy. 

^See author in Jour. Abnorm. Psychol., 1910, June. Relative Value of 
Affective and Emotional Processes in inducing and perpetuating Traumatic "Neu- 
roses." 



166 Interpretation of " Professional-Cramp-Neurosis " 

The Principles of the Psychorthop^dics. — The 
treatment consists of a reconstruction of the impaired func- 
tion under psychological conditions unfavorable to the tic, 
which impairs it. The chief means is graduated exercises 
of the function. In order not to excite the cramp tic, these 
must be performed with great care, but without anxiety, 
very slowly and with attention to minutiae. The sittings 
should be frequent, but short, ceasing as soon as attention 
flags. 

, It is not the exercises themselves which are curative; 
for unless the patient's mental attitude is reformed the 
exercises are useless. Automatic performances are actually 
hurtful. 

As regards writing Meige has adopted a formula of 
round, large, often and little at a time. The largeness is the 
best assurance of sweep and freedom, without which the 
cramp will recur. The roundness renders the changes of 
direction gradual; for abrupt arrests tend towards cramping. 
Frequency is required both to exercise the attention and to 
attain once more a useful habit. Fatigue must be avoided 
by short sittings. 

A new automatism is freer from tendency to cramp 
than is the older one, provided that are borne in mind the 
precautions against cramping, viz., slowness, largeness, 
roundness, frequency, and little quantity. Hence, a new 
position and style of caligraphy is to be recommended. This 
is the more easy and advantageous in proportion as the old 
position and style were faulty. 



AN HYPNAGOGIC HALLUCINATION WITH 
DREAM CHARACTERS 

BY C. S. YOAKUM 

The University of Texas 

THE subject of this hallucination or dream is a 
normal, healthy individual about thirty years 
old, who has never been troubled with halluci- 
nations and dreams very infrequently. Once in 
a while, he tells me, he has the familiar experience of seeing 
himself at the top of a flight of steps or at the edge of a low 
embankment. He seems about to step off and at this point 
of the hypnagogic state awakens with a jerk, the tremor of 
which remains noticeable after he is fully awake. 

The account which follows was jotted down in notes 
immediately after the incident occurred and written out 
in substantially the form I quote, on the following day. 
The subject is well trained in ordinary psychological in- 
trospection, and the incident is quite fully reported. 

"I retired about ten-thirty on the evening of March 
the 29th, 1912, feeling quite well but slightly disturbed over 
a problem whose solution was difficult to reach, and had 
been troubling me for some weeks. The weather was warm, 
but seemed not uncomfortably so. After tossing about a 
considerable time I still found it impossible to sleep. 

"Opening my eyes I tried consciously to determine the 
reason for the sleeplessness. I had played baseball a half 
hour or so during the afternoon, a somewhat unusual bit 
of exercise, and felt perhaps slightly more fatigued than 
usual. Earlier in the evening I played a game of billiards, 
and retired just after reading an account of the work on the 
Panama Canal. None of these things offered a satisfactory 
solution of the difficulty, so I turned over on my back, head 
on the pillow and arms behind my head, in order to relax. 
This is a remembered restful position, but one in which I 
do not dare to sleep, and realized it at the time. If I remain 
in this position and fall asleep, I soon waken with an intense 
numbness in the arms. 

167 ' 



168 An Hypnagogic Hallucination with Dream Characters 

"While In this position I began to think about a large 
bridge party I had attended on the preceding day. This 
was the first afternoon card party that I had ever attended, 
and only the second time I had played cards within a year. 
The visual imagery of the room and the players came back 
with considerable vividness. Especially vivid was the 
portion of the room in which I sat and the tables at which 
I played. In going over the varied events and scenes of 
that afternoon, the remark of the hostess was recalled. 
She had announced that there would not be time to finish 
the series before refreshments would be served. At our 
table we began to count the games played, but did not en- 
tirely decide the issue then. 

"Lying here and running over these events of the previ- 
ous day, I remember distinctly beginning to repeat this 
calculation with the definite intention of satisfying myself 
of the correctness of the hasty conclusion of the day before. 
In order to do this, the number of tables at which I was seated 
and the partners with whom I had played must be repeated 
in memory. All of this was done consciously and again the 
estimate almost completed when the recalled and correct 
features of the train of imagery suddenly ceased. 

"An alcohol lamp and tea tray were brought in through 
the front entrance and placed about fifteen feet in front and 
to the right of where I was sitting. This was in the same 
room, however, where I had been placing the imagery of 
the moment before and the tea tray seemed to be brought 
in by the husband of the lady who had made the announce- 
ment mentioned above. As soon as this occurred, I found 
myself near the teakettle and looking at it. It seemed 
placed on something, there is no recollection what, but at 
such a height that by a very slight bending of the head it 
stood on a level with the observer's eyes, when standing. 
How I got there from the sitting position at the card table 
and what became of the people in the room there is no 
intimation. Suddenly and at no appreciable interval from 
the time when this imagery of the boiling kettle appeared 
there came a blinding flash and an explosion. The sound 
seemed perfect, a 'poof and muffled sound of the explosive 
type, and at the same time there was the flash of burning 



C. S. Yoakum 169 

alcohol, with its blue and yellow flames. None of these 
seemed to come directly to the eyes but went ofi" to the right 
and left and downward, while others shot directly out at 
right angles. All appeared, instead of flashing straight out 
or upward from the bottom of the vessel, to go downward. 

"My eyes shut quickly, the body seemed to jerk, and 
the arms and head were thrown back violently. 

"At this juncture I awoke or became conscious, i. e., 
this second train of imagery ceased. The first thought 
either before waking or upon waking was: are my eyes hurt.^ 
The second suggestion was that, the movement made was 
definitely real and did not seem to extend below the arms, 
shoulders, head, and muscles of the upper part of the chest. 
The remainder of the body was perfectly quiet, or seemed 
so in contrast to the violence of the movements just ceasing. 
The reality of the experience did not cease till I had opened 
and shut my eyes and noted that my arms and head were 
uninjured. Especially did the fact that this was felt to 
be a real experience center in the test of the eyes and eye- 
lids. They were tried at once consciously, and it was noted 
with relief that they did not even feel strained as I immedi- 
ately recalled they do after a waking experience of this kind. 
Further it did not appear that the other parts of the body 
concerned were especially tense and aroused after the move- 
ments and emotions of fear. The actuality of the move- 
ments can be vouched for both as a part of the dream state 
and in the waking state. They lasted over the transition 
distinctly and clearly. The sleeping-room was lighted 
enough to discern vaguely the outlines of the walls and to 
give a sense of their distance. This was also noted and 
consciously used as a test of the non-actual character of the 
experience. The distances of the objects seen in the hal- 
lucination or dream differed. distinctly from the more dis- 
tant walls and spaces in the shadowy room. 

"The point where the waking thought went into the 
hypnagogic state can be located definitely neither by memory 
nor by introspection. The sense of the waking imagery of 
the real tables and persons transformed itself into the 
imagery of the person carrying the tray with no imaginal 
break. 



170 A7i Hypnagogic Hallucination with Dream Characters 

"In the moments that followed, before going to sleep 
and while the few notes were jotted down, several possi- 
bilities in previous experiences that might have entered 
the make-up of the dream came to mind. It is easy enough 
to see how the coffee of the afternoon served to recall numer- 
ous teas at the house of the friend who was also hostess 
on this occasion. At these teas the small alcohol lamp and 
its accessories are always in evidence. Some ten or a 
dozen years before the writer had an accident with an 
alcohol blast lamp, where to avoid an explosion or serious 
fire he was forced to throw the lamp out of a third-story 
window. Usually since, when alcohol is burning too 
strongly, I am reminded of this earlier occurrence." 

As stated above, the rough notes made by the subject 
of the hallucination were written out by him on the follow- 
ing day. He tells me that as he wrote the phrase, "the 
tea tray seemed brought in by the husband," he suddenly 
remembered that he had been in the clubhouse the morning 
before the party when this man carried in through the front 
entrance a silver tea set. This had been no part of the 
actual events of the afternoon, but was the first bit of 
imagery that can be definitely assigned to the dream state. 
It may be remarked here that the use of the front entrance 
had baffled the narrator's power to explain up to this time, 
as all refreshments at the club are brought to the guests from 
the serving-room, which is in direction opposite the front 
entrance. 

Further questioning elicited the following facts about 
the setting of the afternoon bridge game. The emotional 
strain of the afternoon was extreme. Our subject was not 
accustomed to such afternoon affairs and felt that he was 
out of his element. He preferred rather to be at his office, 
and, in addition, did not feel that his knowledge of the game 
warranted the place he was taking among experts. He met 
on entering the room a friend whom he had not seen for 
some time and wished that he might converse with him 
rather than play at a considerable distance from this friend 
during the afternoon. There was present also a person 
whose relations to the writer had not been (and still are not) 
of a satisfactory sort, so that he was not on speaking terms 



C. S. Yoakum 171 

with this individual. All three of these elements were 
conscious accompaniments of the day's events. In addition, 
the behavior of the players and the somewhat desultory 
conversation were features of considerable interest and 
attention. Altogether, the afternoon contained incidents 
that make for easy and abundant recall of detail. 

In the train of thought that preceded the hallucination 
we find no important evidence of the varied attention that 
characterized the afternoon. Only a portion of the events 
were present and those of an incidental character. The 
decision to recount the games represented a state of mental 
apathy to the repetition of the entire situation that accords 
well with the reclining posture, the distractions produced 
by sleepiness and the muscular uneasiness left over from the 
ball game. Though these immediate distractions prevented 
the repetition of the entire situation they did not have any 
distinct imagery of their own. The centers concerned in 
the afternoon bridge game were forced into a semi-aroused 
condition. 

Two possible explanations offer for the location of the 
hallucination. The position of the tray and lamp was ex- 
actly that of the person with whom the subject is not on 
speaking terms. On the other hand, the arms were in an 
unnatural position above the head, and the slight headache 
and nervous uneasiness felt on retiring suggest the possi- 
bility of the not infrequent jerkiness of the relaxation period 
mentioned above. In fact the sleeplessness seemed due 
to this .slightly excited neuro-muscular condition. The 
visual imagery would normally be in front of the person. 
In this case the aroused motor effects were largely limited 
to the upper part of the body and especially to the right arm 
that had been used in throwing. In normal dream states 
we would readily expect those portions of the body to be 
concerned more particularly than the less strained parts. 
The first explanation involves a distinct bit of symbolism 
and a total substitution of imaginal meanings or context. 
The imagery of the dream state is scarcely changed enough to 
warrant this, though it is not a part of the previous experi- 
ence. 

The second suggestion follows directly from the known 



172 An Hypnagogic Hallucination with Dream Characters 

condition of the psycho-physical organism. The usual laws 
of memory recall, e. g., recency and vividness, combined 
with the unnatural position and strains of the upper portion 
of the body locate and suggest the dramatic character of 
the imagery. It is true, still, that the social difficulty with 
the person in question is also of a dramatic character and 
might easily be made explanatory if we accept the theory 
of substitution. 

Let us view the experience a moment as an hallucina- 
tion. The visual, auditory, and kinesthetic sensations 
were natural and real. It required a distinct mental process 
to assure the subject that this thing had not happened as a 
part of the vital experience in which some real physical 
injury was done him.- The colors of the flame were recog- 
nizable, and the sound of the explosion had distinct attri- 
butes. There was no noticeable break in the transition 
from the easily identified imagery of memory to that be- 
longing in no wise to the situation rehearsed. The feeling 
of relief that followed the discovery that there was no pain 
or injury corresponds well with similar feelings in acci- 
dental explosions of like character. The extreme vividness 
of the emotional state during the experience goes as an 
integral part of the state whether we call it a dream or an 
hallucination. In addition, the important physical and 
mental conditions of hallucinatory experiences are present.^ 

The ordinary hypnagogic hallucination lacks the 
vividness and detail of the incident here described. Yet the 
time of its occurrence naturally places it in that category. 
Possibly the shortness of the series of events and their 
apparent rapidity (in the dream) tend also to place it here. 
The usual descriptions of hypnagogic hallucinations, how- 
ever, suggest that they are rather vague floating bits of 
imagery, generally of simple colors and scraps of objects 
that remain uncombined and unrelated. 

The dream characters in the incident are particularly 
clear. We have the logical ordering of events that here 
could easily correspond to a real sequence of events, but do 
not and in all probability would never do so except in a quite 
absurd situation. This logical sequence shows a dramatic 

^Storring, G., Mental Pathology and Normal Psychology, pp. 21—24. 



C. S. Yoakum 173 

gathering of details with a strong emotional climax. There 
remains in it no intimation of the actual bodily conditions 
just preceding the dream, and waking from the event has 
all the usual accompaniments of the dream rather than the 
more permanent after-eflFects of an hallucination. We have 
finally the possibility of explanation in terms of symbolic 
representations. 

A special point of interest noted by introspection is 
the three forms of reality presented by the experience. The 
weak waking reality still carries with it certain undeniable 
features. The position and strains of the body, the memory 
and slightly divided interest (self-conscious) form of imagery 
together with its foreshadowing of a vague end to be reached 
in the specific mental process in progress. These disappear 
during the hallucination only to reappear when waking 
consciousness resumes uts sway. 

If introspection may be trusted here, the hallucinatory 
reality differs essentially from this. Self-consciousness or 
the purposiveness of the self-interest does not shift; it simply 
drops out. In this case there is absolutely no means of 
telling when the dream began, but there is as definite a 
sensing of the loss of the self and its body position as there 
is later of the events of the dream. We cannot, of course, 
oflfer a bit of direct introspection at this point; the type used 
may well be a bit of reading in of the feeling of difference 
of the last rather than the first change. But the last phase 
of the certain wakeful thought before the dream is of this 
foreshadowing emptiness sort that is confirmed by the next 
change when consciousness returns. The nearest de- 
scribable feeling in the waking consciousness is that of high 
emotional excitement. There are moments in such a state 
that seem, looking back at both, highly similar to the state 
of mind in this hallucination. 

Contrasting the mental condition that followed the 
dream with the dream itself, we get the distinct feeling that 
this is a normal dream state. The return of waking con- 
sciousness retains the memory of the dream imagery, the 
drearn emotion, and the dream logic. It rushes back to 
bodily positions and surroundings, to other memory events, 
to another sort of sequence. An essential point differentiat- 



174 An Hypnagogic Hallucination with Dream Characters 

Ing the two seems to be that whereas in the dream sequence 
they are simply coming together, in the waking sequence they 
were together as well as are coming together. This is 
practically a description of the memory process, it is true, 
but there seems to reside in it the intangible intimacy that 
is wholly lacking in the dream state. 

The incident described here illustrates well the function 
of the whole coenesthesia. We have before us a transition 
from the full waking state to a drowsy one in which the 
prominent elements of the sensory factors are those that are 
abnormally awake, the arms and upper parts of the body; 
and the final subsidence of these from consciousness. The 
effect of arousing in the second state a new and previously 
powerful train of thought is continued as a third state in 
the neural centers, without the directive force of the usual 
motor centers with their outlying muscles and viscera. 
The imagery of the weak waking thought was not complete, 
it barely began a group of earlier, emotionally stressed pro- 
cesses and left them without these normal directive agencies. 
There is no good reason for describing this particular mental 
event as a split in consciousness or as concerned with any 
subconscious mental processes. All the elements appear 
as memory processes, they merely lack the usual coherence 
of such. 

. Strictly speaking, we must place this in a class with 
hypnagogic hallucinations. It is, however, a particularly 
vivid and complete case, and offers an illustration of the 
intimate relation that exists between dreams and halluci- 
nations proper. The only definite criterion that suggests 
itself to distinguish the dream from the hallucination lies 
in the two states of the waking consciousness that respec- 
tively accompany and precede the state in question. In the 
hallucination proper, consciousness does not connect with 
previous waking states, to the bodily factors in their normal 
form, with the immediacy and completeness that the waking 
state following an ordinary dream exhibits.^ 

The explanation offered is, that, in the hallucination, 
the coenesthesia and external stimuli are not so entirely 
excluded from exerting their controlling and directive in- 

1 Ellis, Havelock, The World of Dreams, pp. 182 and 188. 



C. S. Yoakum 175 

fluence upon the progress of the imagery as they are in the 
dream. The result of this difference makes the hallucina- 
tion a far more powerful factor in affecting the later trains 
of thought. Pathologically the hallucination becomes, 
therefore, a more serious influence in shaping the thought 
of the individual than the dream, and seems to point to a 
more serious defect in the neuro-muscular processes, or 
complex union of central and peripheral factors we call the 
self. 



THE CEDIPUS-COMPLEX IN THE PSYCHO- 
NEUROSES' 

BY ISADOR H. CORIAT, M.D., BOSTON 

ONE of the most important of complexes is the 
CEdipus-complex, as it frequently furnishes the 
underlying mental mechanism of many psycho- 
neuroses and of abnormal sexual inversions. 
This CEdipus-trend usually has its origin during the earliest 
years of childhood and in adults it may appear in dreams, 
in the form of a psychoneurosis or as homo-sexuality, the 
latter originating as a reaction of defense against the sup- 
pressed and unconscious CEdipus ideas. The most convenient 
and readiest method of analyzing this CEdipus-complex in 
adults is through the dreams. These dreams may appear in 
two distinct types, either as a literal incest dream, or as is 
more commonly the case, in a disguised and symbolized 
form, such as the death of the father.^ Even the literal 
dreams, however, as will be later demonstrated, frequently 
contain many symbolized and disguised elements. If the 
suppression of the complex has been inefficacious, the 
Qidipus-trend appears literally in the dream; if the sup- 
pression has been completely successful, due to the building 
up of incest barriers, the complex becomes markedly sym- 
bolized. The degree of symbolism runs parallel, therefore, 
with the success of the suppression. 

The complex develops only in those children who have 
been exposed to an over-exuberant love from the parents, 
or who themselves have shown a parental affection of ab- 
normal intensity. The CEdipus dreams originate from 
these infantile elements of the unconscious in the exposed 
individual, and are the symbolic expressions of these elements, 
indicating in an admirable manner this early sexual love of 
the son for the mother. In these cases the later develop- 
ment of the psychoneurosis may be interpreted as the 

^Read before the American Psychopathological Association at Boston, May 
29, 1912. 

-S.Freud, Die Traumdeutung, p. IS-i et seq. S. Freud, Drei Abhandlungen 
Zur Sexual Theorie, p. 72 £t seq. 

176 



I sudor H. Coriat \77 

successful revenge of the nervous system upon this (Edipus- 
complex. In fact, a psycho-sexual family-complex is fre- 
quently the fundamental mechanism of a later neurosis. 
In a previous contribution I pointed out and analyzed 
how an important childhood symptom was a family-complex 
and this in turn led to the development of a typical hysteria.^ 
This psycho-sexual trend is termed the (Edipus-com- 
plex, as it is identical with the CEdipus legend and its 
portrayal in the CEdipus Tyrannus of Sophocles. The oc- 
currence of the complex has also been pointed out in a 
recent analysis and interpretation of the tragedy of Hamlet.^ 
In fact in the light of psychoanalysis the words of Jocasta 
to CEdipus in the Greek tragedy have almost a prophetic 
significance: "Oft times in dreams, have men committed 
incest." Recent studies in comparative mythology have 
also served to throw light upon the relation of this complex 
to the psychoneuroses. In the CEdipus fable are contained 
elements which many psychoneurotics frequently repress, 
namely, an early love for the mother and an early hate for 
the father. Thus the representation of a forbidden wish 
became symbolized in the CEdipus idea. It is this repressed 
wish which has been responsible for the origin of both 
myth and psychoneurosis. Probably, therefore, the CEdipus 
myth arose out of the literal and therefore incompletely re- 
pressed incest dreams or wishes. In the CEdipus fable cer- 
tain childhood wishes were fulfilled and realized in the same 
manner that the conflict between father and* son was repre- 
sented by the myth of Uranos and the Titans. Thus myths 
contain the infantile mental life of man, representing and 
symbolizing his childhood ideas and experiences.^ This, 
it appears to us, is a far more logical attitude than to in- 
terpret CEdipus as a solar hero, and the expiation for the 
incest crime merely a later addition to satisfy a moral 
feeling.^ 

^Isador H. Coriat, A Contribution to the Psychopathology of Hysteria, 
Journal Abnormal Psychology, Vol. VI, No. 1, April-May, 1911. 

^Ernest Jones, The CEdipus Complex as an Explanation of Hamlet's Mys- 
tery. American Journal Psychology, Vol. XXI, No. 1, Jan., 1910. 

^K. Abraham, Traum und Mythus. Eine Studie Zur Volkerpsychologie, 
1909. 

*John Fiske, Myths and Myth Makers, 1872. 



178 The (Edipus-Complex in the Psychoneuroses 

This naturally brings us face to face with the problem 
of infantile sexuality, particularly sexual inhibition, the 
incest complex with its later barriers and the relation of 
these to the origin and development of the psychoneuroses. 
That this GEdipus-complex may exist is proven from the 
results of psychoanalysis, and that this complex can pre- 
determine a later psychoneurosis and appear in a literal or 
symbolized form in dreams is an incontestable fact. In 
fact, the complex represents an unconscious fixation for the 
mother. The mechanism of how it does this is probably 
the sinking of an infantile wish into the unconscious. There 
the censorship finds this incest trend to be incompatible 
with consciousness, and therefore when it reappears it does 
so in a disguised form, either as a psychoneurosis, morbid 
anxiety, or a symbolized dream. Sometimes when the 
censorship is not sufficiently strong, the incest-complex 
appears as a literal dream, although it may contain disguised 
elements. Thus it seems, in some cases at least, where it is 
possible through means of psychoanalysis to reach the child- 
hood sexual processes, that the sexual instinct appears in the 
form of a clear incest-trend, sometimes disguised in the 
shape of over-affection for the mother, sometimes a distinct 
libido whose excitement is reached through various non- 
sexual erogenous zones, and finally sometimes in the form 
of- an open hate and hostility toward the father. The 
neurotic symptoms result from the repression of this incest 
libido and the 'attempt of the censor to create an amnesia 
for this CEdipus-trend is purposeful, but sometimes un- 
successful, for the Qidipus elements may break through 
into consciousness later in life. 

Sometimes the sexual feeling for the mother may be so 
intensely suppressed and so associated with the feeling of 
shame and guilt, that a compromise arises in the form of 
homo-sexuality. This mental mechanism took place in a 
case of homo-sexuality which I had occasion to analyze. 
Here the homo-sexual change took place at puberty, at 
which time the subject identified his mother as a sexual 
object in his day dreams, because in early childhood she 
had allowed physical relations of a sexual nature. 

The QEdipus-complex dream is a disguised incest symbol, 



Isador H. Coriat 179 

In the same manner that language is full of metaphorical 
sexual symbols, both furnishing a convenient aesthetic 
method of expressing sexual matters which could not other- 
wise be expressed in a more direct and coarser manner. 

As attention in the clinical material will be chiefly di- 
rected to the analysis and development of the (Edipus- 
complex, only such other data of the individual cases will be 
given as may be necessary to elucidate the origin of the 
complex, its later appearance in the dreams and the reac- 
tions of defense toward the complex which caused the 
symptoms of the psychoneurosis. In the four cases studied, 
and in the homo-sexual case briefly referred to earlier in the 
course of this paper, the CEdipus-complex was probably 
the chief mental mechanism at work in the formation of the 
psychoneurosis. In one of the cases where reveries of pain 
acted as a sexual stimulant, it was but a step to the formation 
of an CEdipus-complex, where the inflictor of pain was 
identified with the subject's mother. In two of the cases 
the CEdipus-trend arose as a defense-reaction against a 
family conflict. In the fourth case the CEdipus-complex 
caused distinct anxiety attacks, while the dreams furnished 
interesting examples of number symbolisms in which the 
complex was hidden. The dreams in all our cases were 
built upon the entire suppressed pathogenic complexes. 
This is shown by the fact that the CEdipus idea ran through 
all the dream material. 

Thus it seems, from an analysis of my clinical material, 
that in subjects who were either predisposed to psycho- 
neurotic disturbances, or who had been exposed to an over- 
exuberant parental affection, sexual impulses of an abnormal 
nature may be demonstrated early in childhood life. This 
impulse may be quite complicated and may take the form of 
masochism, sadism, or the development of an CEdipus-trend. 
Part of these impulses were wishes and part were erotic 
fantasies, in which the wish element was entirely absent. 
These abnormal sexual tendencies, however, laid the founda- 
tion, through their repression into the unconscious, for the 
later development of a psychoneurosis, — in fact, in our 
material, the psychoneurosis was due to the bursting forth 
of these unconscious elements into adult life. There, it was 



180 The (Edipus-Complex in the Psychoneuroses 

either partially symbolized in the form of symptoms, dreams 
or abnormal behavior, or it appeared in a literal form, with 
disguised elements, according to the degree of successful 
repression. The amnesia for this (Edipus-complex was 
successful and striking. The complex could be reached 
only after great resistance through the analysis of disguised 
or literal dreams containing the (Edipus-trend.^ It was out 
of these unconscious, infantile sexual elements that the 
CEdipus-complex developed. 

The reaction to this incest-complex in three cases was a 
means of secret pleasure and gratification to the patients, 
in the same way that they found pleasure in their abnormal, 
auto-erotic fantasies and voluptuous reveries. In the 
fourth case the complex gave rise to painful attacks of 
morbid anxiety. In order to avoid repetition other details 
will be given in the course of the individual analyses. 

Case I. — A, a young man, twenty-five years of age, 
had suffered for eight months before he came under observa- 
tion from a well-defined and gradually increasing psychas- 
thenia, of the type of a compulsion neurosis. At the time 
of the onset of his psychoneurosis, he noticed a gradually 
increasing abnormal fatigue, sleeplessness, and restlessness, 
which he attributed to his work, but which, nevertheless, 
was not dissipated by rest. Shortly afterwards he began 
to- notice that in his work as an analytical chemist there 
developed a tendency to wash various pieces of laboratory 
glassware a number of times before he became certain they 
were clean. In his analytical work, also, he began to doubt 
the accuracy of his calculating and weighing, and was in 
continual fear of making errors. These repetitions of 
actions gave him a sense of relief, whereas if he resisted the 
repetition he would soon become restless, and at times 
develop typical anxiety attacks. Indecision in his thought 
and behavior became marked. For years the sexual tend- 
encies have been abnormal, the details of which it is not 
necessary to relate except to state that he has strongly 
repressed the memory of his various abnormal sexual acts. 

On analysis, the compulsive acts and the mania of 

^Isador H. Coriat, Psycho-Analysis and the Sexual Hygiene of Children. 
The Child. Vol. II, No. 4, January, 1912. 



Isador H. Coriat , 181 

repetition could be clearly shown to be reactions of defense 
and compromises with the suppressed sexual ideas. These 
continual repetitions finally became an automatism which 
completely dominated and mastered him. Finally there 
developed strong irresistible impulsions to pick up and 
accumulate all kinds of useless rubbish. If these impulses 
were resisted, a typical attack of cardiac anxiety would 
develop, whereas if yielded to, there followed a sense of 
relief akin to his former sexual satisfaction. The dreams 
were either disguised sexual symbolisms, or were literal re- 
hearsals of his past abnormal sexual acts. In a psycho- 
analysis of the condition, among other interesting dreams, 
the following typical Q^dipus-complex dream was recorded 
and analyzed. It seemed to furnish the main complex 
responsible for the development of the psychoneurosis and 
its elements could be traced back to the earliest years of 
childhood. 

Dream. He seemed to be engaged in the sexual act 
with his mother, whose body in the dream resembled that 
of a young girl. During the act there was neither excite- 
ment nor a feeling of revulsion. The dream suddenly 
terminated by a knock at the door and the entrance of an 
unrecognized person into the room. 

Analysis. Five years after the marriage of the patient's 
mother, she gave birth to twins, the patient himself and a 
brother. His father was a number of years older than the 
mother. She was his second wife and on his marriage he 
brought a young son, by his first wife, into the new house- 
hold. Before the patient's birth, his mother had some 
difficulty with her stepson until finally the boy was sent 
away from home, and he very rarely saw his step-brother 
after this episode. In consequence of his father's first 
marriage, he always felt that he did not obtain the full share 
of his father's love, because he considered that he was more 
closely attached to the son by the former wife. This emo- 
tion of resentment towards his half-brother could be traced 
back to the earliest years of childhood, in fact the subject 
could not recollect a time from which this feeling was absent. 
During these early years he also doubted if his father were 
lavishing upon his mother the full share of love and attention 



182 The (Edipus-Complex in the Psychoneuroses 

to which he felt she was entitled. He was certain that the 
memory of his father's first wife and the feeling that perhaps 
his paternal affections were stronger for her and for their son, 
were strong factors in this sense of hostility. 

As a result of this reasoning and mental conflict, he 
developed the idea that his (the patient's) love for his 
mother was greater than his father's affection for her, and 
as a consequence, for years and even up to the present time, 
he has had more aflPection for his mother than for his father. 
For instance, he has more confidence in his mother and has 
confided matters to her which he has never told his father, 
because he felt that his mother understood him better. So 
far as he could observe during the early years of childhood 
his father at least never outwardly showed much affection 
for his mother, and, therefore, as a compensation he began 
to demonstrate an over-fondness for her. He would so 
fondle, hug, and kiss his mother in public, that bystanders 
would comment on this attitude of over-affection. 

Up to a certain age the household arrangement was 
such that his twin brother slept with his father, while he 
slept with his mother. This plan particularly pleased him, 
as it gave him the opportunity of intimate physical contact 
with her. The arrangement continued up to the time he 
was about ten years of age. Then a change took place, and 
he and his twin brother slept together in a bed which was 
placed in their parents' room. He was admonished, how- 
ever, by his mother, that if he were afraid to sleep alone, or 
if at any time he became frightened during the night, he 
could come to his mother's bed again. Thereupon shortly 
afterwards he purposely would cry out and manifest great 
fear during the night, would make excuses that he was 
nervous in order that he might be taken to his mother's bed 
and thus replace his father, who under these circumstances 
would be compelled to sleep with his twin brother. On 
these occasions he would imagine that he was giving his 
mother an amount of affection which she did not receive 
from her husband, would embrace and kiss her, etc. At 
about the same time he began to feel that his father was cold 
in his attitude towards him and loved his twin brother 
better, a mental conflict which soon developed into a marked 



I sudor H. Coriat 183 

but repressed hostility towards his father. Once while 
sleeping with his twin brother he accidentally saw the sexual 
act between his father and mother. This he interpreted 
as a vulgar species of masturbation with which he was ac- 
quainted, because he had already aquired the habit and he 
resented that any one, even his father, should treat his 
mother in that manner. 

In addition, for years he feared that another child 
might come into the family. Any such occurrence would 
have meant to him a terrible calamity because he knew that 
the inevitable consequence would be that his mother's love 
would naturally be expended on the young infant, to the 
neglect of him; and secondly, he knew that pregnancy, for 
a time at least, would deform his mother's body. This 
latter was especially distasteful to him, as he experienced 
the most voluptuous sensations by rybbing his hand over the 
skin of various portions of his mother's body, and some- 
times these actions were associated with a marked libido. 

Thus little by little his hostility towards his father grew 
stronger and stronger, he respected him less and less, and, 
consequently, he became more strongly attached to his 
mother. As his father took a domineering attitude towards 
his mother, he felt that he must protect her, particularly since 
his twin brother seemed more strongly attached to his father. 

On a number of occasions he has dreamed that either 
his father or twin brother were dead, a disguising of the 
CEdipus-trend, resulting in an unconscious wish-fulfillment 
of their deaths, so that his attitude to and his relations with 
his mother might be undisturbed. His twin brother also 
entered into these dreams, because he felt that this brother, 
like his father, was antagonistic to his mother and, therefore, 
he unconsciously wished both removed, although the wish 
was suppressed and only appeared in a disguised, symbolic 
form. As he grew older his day dreams of the ideal woman 
he desired for a wife always took the form of some one who 
resembled his mother in physical appearance and character, 
sometimes indeed the woman would be actually identified 
with his mother. Later other CEdipus dreams appeared in 
which the incest complex was transferred to an indifi"erent 
person, usually much older than the patient, and yet on 



184 The (Edipus-Complex in the Psychoneuroses 

analysis this person could always be identified with his 
mother. 

Thus there has been given an extended analysis of a 
dream showing a typical, undisguised CEdipus-complex. 
This literal CEdipus dream is rather rare, as in most cases the 
incest-complex is usually disguised and assumes the form 
of the death or the funeral of the person who interferes with 
the love towards the mother — that is, the death of the 
f-ather. The intense desire to sleep with his mother was for 
the purpose of interfering in any further sexual acts, and to 
prevent his mother being rendered ugly and deformed 
through pregnancy. Thus he not only learned to love his 
mother, but on analysis this feeling for her could be shown 
to have a sexual basis. As he grew older, this impulse to a 
definite-object selection was interpreted as an incestuous 
fantasy, which profoundly influenced the development of 
the compulsion neurosis. 

In the CEdipus dream there is an interesting displace- 
ment, the mother appearing as a young girl, thus represent- 
ing the imaginary wish-fulfillment that his mother were a 
younger woman. Although there was no open hostility 
displayed against his father, yet a repressed hostility could be 
demonstrated, because he felt that his father was a rival 
for his mother's love. When quarrels took place at home, his 
twin brother would side with his father while the patient 
would take his mother's part, so that she would not stand 
alone. 

It is interesting to note, that while the patient wac in 
the habit, during the course of the analysis, of writing down 
all his dreams, yet he omitted to write the dream containing 
the incest-complex, merely relating it verbally and excusing 
his failure to write it down because he considered it un- 
important. This failure to spontaneously relate a dream 
is an example of a trick of the censor, an effort of the un- 
conscious to prevent the complex from reaching conscious- 
ness. In the analysis of the dreams containing the CEdipus- 
trend, the resistance was marked because of the strong 
repression. 

Thus the disguised and undisguised CEdipus dreams in 
this case arose from a repressed complex of an incest wish. 



I sudor H. Coriat 185 

The particular dream analyzed was markedly condensed 
and literal. The nakedness in the dream was an erotic 
symbol of childhood joy and delight in exhibitionism. The 
simulated fear at night when sleeping alone was for the 
purpose of entering into closer physical contact with his 
mother, a mental mechanism analogous to simulated foolish- 
ness in hysteria. 

The dream showed several complexes, namely, an in- 
cest-complex, a displacement-complex, and an exhibitionism- 
complex. It is interesting, too, that in spite of an CEdipus- 
trend, there was no sexual excitement in the dream, a kind 
of an unconscious wish to neutralize the incest-complex due 
to the building up of incest barriers. Yet on the other hand, 
a sense of revulsion was absent, demonstrating that although 
a sexual feeling might be incompatible with consciousness, 
yet this absence of revulsion might be a compromise for 
excitement. Why the dream was not completely symbolized 
can be answered only on the supposition that there was a 
weakened censorship, leading to an incomplete suppression 
of the complex. 

Case II. — B, a young man thirty-two years of age, 
for a number of years had suffered from a psychasthenic 
condition in which he felt compelled by certain tests to 
search out omens in nearly all the acts of everyday life. 
These omens or testings finally became so severe and reached 
such a complex degree, that he became greatly depressed, 
and obsessed by marked religious scruples. At the height 
of the compulsion of omen testing he would have a typical 
attack of anxiety, with restlessness, tachycardia, and dryness 
of the mouth and tongue. In this case there was a marked 
sexual hypersesthesia and it could be demonstrated through 
a psychoanalysis that in early childhood he was subject 
to intense auto-erotic reveries of a sadistic-masochistic 
character. These reveries assumed the type of punishment 
by a woman. This latter was closely interwoven with com- 
plicated and marked abnormal religious ideas and scruples. 
In the course of the analysis, a well-developed psycho- 
sexual family-complex could be demonstrated. Through 
the dream analysis it could be shown that it was but a step 
from the sexual ideas of being subdued and punished by a 



186 The (Edipus-Complex in the Psychoneuroses 

woman to the development of a fully developed CEdipus- 
complex, particularly since the active punisher was identified 
with the subject's mother. 

Dream. He seemed to be in the company of an older 
man and was about to buy some yellow roses for his father's 
funeral. In the dream there seemed to be little or no emo- 
tion concerning his father's recent death. Then the dream 
suddenly shifted and he appeared to be in a carriage, driving 
home from his father's funeral. He was quite jolly, and 
although in the dream this did not seem quite the proper 
attitude at such a time, yet no attempt was made to sup- 
press this exalted state. 

Analysis. This is a typical, disguised CEdipus-complex 
dream based upon an imaginary wish-fulfillment. Both the 
father and mother were alive and in good health at the time 
of the dream. As a child he was decidedly over-fond and 
over-affectionate towards his mother, but thought less of 
his father, in fact towards the latter he was hostile in a blind, 
unreasonable manner. 

At a very early period of life he began to have sexual 
excitement of a peculiar nature. On analysis this was found 
to be a form of ideal or psychical masochism. He would 
imagine himself physically exposed by a definite woman, 
and then whipped upon the exposed buttocks. This 
imaginary punishment would be the source of an intense 
sexual excitement. These masochistic tendencies were 
either actually visualized at night, while he was in bed, or 
they formed part of his childhood reveries during the day. 
In association with the infliction of the punishment and 
consequent pain, on analysis there could be demonstrated 
a typical CEdipus-complex. In other words he always 
selected for the active punisher a married woman with 
children, about his mother's age, a kind of substituted 
incest-complex. Finally this imaginary punishment was 
carried to a point where the woman physically and mentally 
not only resembled his mother, but in time actually became 
his mother. Thus in a roundabout imaginary masochism 
he managed to have sexual excitement with a kind of sub- 
stituted mother, in reality a typical CEdipus-complex. 

In addition he would lie awake during the night and 



Isador H. Coriat 187 

allow these ideas of passive cruelty to flit through his mind, 
and with the ideas there was associated an intense sexual 
excitement. Gradually there occurred a transference of 
his sexual punishment to ideas of religious punishment for 
imaginary sins and blasphemies, because he felt that these 
sexual ruminations were wrong and sinful. Sometimes these 
feelings of subjugation would reach such a point that he 
would imagine he were locked in a room, in order that the 
idea of complete subjugation and bondage might be intensi- 
fied. 

There have been frequent dreams of his father lying 
dead in a coffin, but he has never dreamed of his father 
coming to life after death. He has, however, dreamed of 
his mother lying in a casket and as he watched, her body 
would come to life. Here we have distinct exahiples of an 
unconscious wish-fulfillment. There have also been dreams 
of a literal (Edipus variety. In these dreams his mother 
appeared much younger, here again a wish of the uncon- 
scious for sexual excitement with his mother, who must 
at the same time be a young woman. Sometimes the 
sadistic-masochistic imagery would become elaborated and 
highly dramatic; for instance, he would imagine that he was 
imprisoned by a powerful woman and kept a prisoner for 
purely sexual purposes. Since sexual ideas in association 
with his mother were repulsive to him and since he repressed 
these, he attached his libido to other women whom be sub- 
stituted for his mother in all details except in name. The 
infliction of pain by a beloved person is a form of erotic 
symbolism exercised through an unconscious mental mech- 
anism which has a sexual coloring. In the analysis given 
above, the unconscious masochistic mechanism was a typ- 
ical Q^dipus-complex, but disguised and symbolized because 
of the feeling of repulsion towards an incest trend. 

Case III. — C, a young man twenty-four years of age, 
for several years had been troubled with a phobia of red. 
Whenever he looked at a red object it seemed living and 
animated. This phobia followed a so-called nervous break- 
down four years previously, in which, among other symp- 
toms, there developed a fear of insanity, attacks of anxiety 
and depression, fatigue, a fear that he might commit suicide 



188 The (Edipus-Complex in the Psychoneuroses 

by throwing himself down from high places, etc. For years 
he felt that he was physically unattractive. He therefore 
did not seek the company of women, but was in the habit of 
acquiring his sexual satisfaction by erotic reveries of mutila- 
tion of the genitals of himself and others, in his imagination 
torturing them without the use of an anaesthetic. The 
absence of any anaesthesia always furnished an integral 
portion of these reveries. This psychical sadism and mas- 
ochism often took on the character of a most elaborate 
ceremonial, such as initiation into some secret society, a 
medieval festival, or imprisonment of the imaginary victim 
in an old feudal castle or dungeon. In these reveries and 
day dreams the blood which resulted from the imaginary 
tortures on analysis proved to be the unconscious mental 
process which finally developed into the phobia of red. 
Other details are given in the analysis of the CEdipus-com- 
plex, which existed to a marked degree in this subject. 
This complex also furnished a portion of the unconscious 
deterministic process which made up a portion of the phobia 
of red. The (Edipus-complex in this case played a part 
equally potent with the sexual reveries in the formation of 
the psychasthenic state and it appeared in several typical 
disguised dreams. 

Dream. He seemed to be carrying the dead body of 
his father and placing it on a shelf. His sorrow did not 
appear very deep, although his mother, who was present, 
seemed greatly grieved. He attempted to pronounce the 
burial service over his father's body, but could not seem 
to remember it, and later, when he attempted to extemporize 
such a service, he likewise failed. 

Analysis. In this dream there is a typical disguised 
GEdipus-complex. Early in childhood, because his father 
once returned home intoxicated, there had developed a 
gradually increasing hatred of his father, and as a result 
he avoided him and tried to blot him out of his life. In 
consequence, the love for his mother grew greater and 
greater. He has never wished for a brother or sister, be- 
cause, after the above-mentioned episode with his father, he 
became very jealous and afraid that the appearance of an- 
other child in the family might deprive him completely of 



Isador H. Coriat 189 

his mother's affection. For years he has secretly wished 
for his father's death. Although he strongly repressed this 
wish, yet at any time his father became ill there arose a 
secret joy in the thought that perhaps he might not recover 
from his illness. The fact that he could not remember a 
word of the burial service in the dream, whereas he could 
partially repeat it when awake, is an interesting example of 
censorship, i. ^., he could not remember it because he did 
not wish to remember it. Even before the mentioned episode, 
he never was over-affectionate towards his father, although 
he never had a feeling of hostility. This he explained as 
arising from the fact that his father paid little attention to 
him and never fondled or played with him when he was a 
child. There were times when his mother's attention to his 
father made him intensely jealous, and, therefore, he often 
thought that if his father were dead the source of the jealousy 
would be removed. He was never openly hostile against 
his father, because of the repressed love for his mother. 
Little by little, however, the love for his mother deepened, 
and he desired to be more intimate with her because she 
was of the opposite sex. He has never dreamed of his 
mother being dead. On several occasions, when a child, 
there developed a sexual feeling for his mother, and it was 
only with some difficulty that this impulse was controlled. 

In another dream of a most elaborate character this 
change of attitude towards his father and the increased love 
for his mother was clearly symbolized. This dream was very 
complicated, as portions of it contained a sexual ceremonial 
complex which it is not necessary to relate here. The part 
of the dream containing the repressed family conflict is as 
follows : 

Dream. He seemed to be with his father at the corona- 
tion of King George, waiting for the coronation parade. 
Suddenly the King came, followed by the Queen. The latter 
wore a blonde wig and both acted in a most undignified manner. 
He was, however, attracted to the King. It was afterwards 
learned that they were not the real King and Queen, but 
imitators who had been hired for the occasion. Later in 
the day he met the real King and Queen. The latter re- 
sembled his mother in features and actions, and he immedi- 



190 The (Edipus-Complex in the Psychoneuroses 

ately developed a deep affection for her. The King, how- 
ever, he greatly disliked. 

Analysis. It has been shown that up to a certain age 
the subject liked his father but cared little for his mother. 
Later, however, this affection became reversed. Thus this 
portion of the dream is a disguised (Edipus-trend, and is a 
secondary elaboration of the main theme. The dream dis- 
placement (Queen for his mother, with its consequent 
affection) is very interesting, representing as it does his 
change of mental and emotional attitude towards his mother. 
Later the CEdipus motive reappeared in the following: 

Dream. He seemed to be going through a marriage 
ceremony with a young girl, and his mother seemed to be 
reading the ceremony. Finally when they came to the 
words "love, honor, and obey," both he and the girl refused 
to assent to this phrase, wherewith he was secretly glad. 

Analysis. For years has had the feeling that he would 
not care to marry, because he had the idea that he would not 
wish to degrade his wife by coitus, the same idea which he 
had concerning his father and mother when a young child. 
Further analysis showed that in the dream he was really 
marrying his mother, but the situation was displaced and 
transferred to the young girl because of the incest barrier^ 
although the wish-fulfillment was distinctly present- In 
the dream he abhorred the girl he was about to marry, but 
loved his mother, and preferred to marry her rather than the 
girl. The incest fallacy was not perceived in the dream, 
because again, by a trick of the censor, he did not wish to 
see it. 

The complex again appeared in the following dream. 
He appeared to be in a store and about to purchase a red 
curtain. They did not have it in stock, and when later he 
returned in the company of his mother, it appeared that his 
father had recently died. Analysis of this dream revealed 
the following complex. One night, when quite young, he 
overheard his mother reprimanding his father concerning the 
latter's alcoholic, habits. She stated that if he did not stop, 
that he would die of apoplexy, as this was already indicated 
by his red complexion. After this episode he kept noticing 
his father to see if the complexion continued red, as this would 



I sudor H. Coriat 191 

indicate to him alcoholism, apoplexy, and then death, a 
death which he secretly desired on account of the feeling of 
hostility towards his father. By an over-compensation, his 
love was then transferred towards his mother. 

It is interesting to note that this dream was not written 
down with the other dreams, as was the subject's habit, 
but was told verbally and carelessly because, according to 
his explanation, he thought it unimportant. The real ex- 
planation was, however, that he did not record the dream 
because he did not wish to have it analyzed, as it contained 
some of the most painful elements of the complex. The 
unconscious knew, if that particular dream were analyzed, 
the repressed complex would be reached and the cause of 
the dream brought into consciousness. Therefore the un- 
conscious attempted to hide the dream containing this 
complex by making consciousness believe that it was un- 
important. An exactly similar mechanism took place in 
the first of our reported cases. 

Finally the CEdipus-complex again appeared in the 
following dream, thus demonstrating how the dream-life in 
the course of the psychoneurosis was completely tinged with 
the CEdipus-trend. 

Dream. A red-faced, black-bearded chaplain of the 
Navy was reading a funeral service at the burial of the 
victims of the battleship Maine, Several times in the midst 
of the service he referred to casket number two. Finally 
he opened this casket exposing the body to view. The 
corpse was partially decomposed and white-bearded, and 
on looking at it the patient found that he was gazing at the 
dead body of his father. 

Analysis. Here again the childhood wish-fulfillment 
of his father's death appeared in a dream. A displacement 
again occurred, the fiorid complexion of his father being 
transferred to the chaplain. In the subject's childhood he 
often made imaginary funerals with casket-shaped build- 
ing blocks, and in his day dreams he always imagined he was 
burying his father, never his mother. Not only did he wish 
his father's death in order to gain his mother's entire affec- 
tion, but in order that he might have a stepfather who would 
treat both him and his mother more kindly. Thus the num- 



192 The (Edipus-Complex in the Psychoneuroses 

ber two on the coffin was not an accidental occurrence, but 
predetermined by unconscious complexes, namely, the un- 
conscious wish for a second father and for his mother a 
second husband. In the event of his father's death, he also 
wished that his mother would marry his father's bachelor 
brother, who was rich and prominent, thus developing what 
may be termed a Hamlet complex. 

Case IV. — The following typical case of an anxiety 
neurosis offers an excellent example of the following state- 
ment from Freud: "When a once healthy person merges 
into disease after an unhappy love affair, the mechanism of 
the disease can distinctly be explained as a return of his 
libido to the persons preferred in his infancy."^ 

D, a young man thirty-four years of age, about two 
months after his betrothal to a young woman, began to 
suffer from typical anxiety attacks. The first of these 
attacks took place at night. He awoke from sleep in a 
panic, with a feeling of muscular rigidity, anxiety, and terror. 
At the end of three or four hours the attack subsided, but it 
was repeated on several successive nights. Since then he has 
complained of a sense of lassitude, indifference, and fatigue, 
with occasional anxiety phenomena, these latter were of 
less severity than the earlier attacks. The physical ex- 
amination was negative and there were no stigmata of hys- 
teria. The mental state associated with the physical 
anxiety and sense of precordial distress was an unexplain- 
able sense of repulsion towards his fiancee and a feeling that 
he had committed a grave error in becoming betrothed. 
Therefore he determined to terminate the betrothal, but 
circumstances were such that a marked sense of indecision 
arose. A psychoanalysis, however, conducted partly 
through free association procedures and partly through 
the dreams, revealed the unconscious mechanism of the 
feelings of repulsion and indecision and of the morbid 
anxiety. 

Psychoanalysis. Several weeks before the first anxiety 
attack he began to feel that he was committing a great 
error in planning for marriage, and thus breaking away from 
old family associations. For years there had been a sense of 

^Drei Abhandlungen Zur Sexualtheorie, p. 74. 



Isador H. Coriat 193 

very close intimacy with the family, particularly for his 
mother. In fact, the patient was the eldest of four children, 
and his mother, therefore, had always seemed more in- 
terested in him than in the other members of the family. 
Thus while he was the favorite of his mother, he never felt 
so closely drawn to his father, although at no time was there 
any actual feeling of hate or hostility. It further developed 
that eight years previously the patient had experienced 
another unhappy love affair, although without any symp- 
toms of morbid anxiety. In the light of what follows 
during the course of the analysis, this episode is of sig- 
nificance, for it could be shown that the anxiety did not 
develop then because his feelings for the young woman were 
greater than his affection for his mother, a situation exactly 
opposite to the situation at present. 

For years he was much attached to his mother, and 
even during the period of engagement his mother occupied 
his thoughts to a great extent. The emotional anaesthesia 
towards the young woman seemed, therefore, to be due to 
the inhibitory influence of this unconscious family complex, 
particularly his deep affection towards his mother. Thus 
there arose a mental conflict, — whether to break away from 
old and fixed family ties and associations or to enter into 
the new relationship of marriage, thus severing all relations 
at once, — a typical CEdipus-complex. He entered into the 
new relationship of a betrothal and a possible marriage 
with a mental reservation caused by this complex, which 
had such an inhibitory influence that he could not fully trans- 
fer the affection he felt for his mother to his fiancee. His 
fiancee he considered a rival for his mother's love, and the 
' orbid anxiety was the effort of the unconscious to neu- 
ilize the rivalry and the resulting mental conflict. He 
dd always been over-exuberant in his love for his mother, 
c^nd for years entertained the thought that he could never 
marry while his mother was alive. He has dreamed that 
his father and various members of the family have died, 
but he has never dreamed of his mother's death. Thus the 
mother-complex blocked the aflPection for his fiancee and 
caused the emotional indifference. 

As a result of this analysis, which has clearly laid bare 



194 The (Edipus-Complex in the Psychoneuroses 

an CEdipus-complex, the cause of the anxiety attacks be- 
comes clear, namely, they resulted from unconscious motives 
and incubations in which the repressed love for his mother 
was more powerful than his feeling for his fiancee. Addi- 
tional data showed a neurotic family history and revealed 
the fact that since childhod the patient had been subject 
to states of anxiety and timidity on facing new enterprises. 

An analysis of the dreams revealed other phases of the 
repressed complexes, and also furnished interesting examples 
of number symbolisms or unconscious manipulations of 
numbers. It could be shown that the numbers appearing 
in the dreams were not accidental but that they represented 
the important unconscious mental conflicts of the subject, — 
namely, the CEdipus-complex, — and this bore an intimate 
relationship to the biographic data secured.^ 

Dream. He seemed to be in a lawyer's office. The 
assistant was making notes and writing figures on sheets of 
yellow paper. The figures when added made the sum of 
3,990. These figures seemed to be kind of an inventory of 
the subject's mental make-up, that is, integrity so much, 
honesty so much, etc. The assistant commented that the 
lowest figures were those concerned with the subject's 
affections and finally said, "It is useless to go on with this 
thing," which the subject interpreted as his betrothal. 

■Dream. He seemed to be standing near a large build- 
ing in front of which was a green-colored moving van with 
yellow lettering and the figures 317 at the bottom of the 
team. 

Analysis of the Number Dreams. The first dream seemed 
to reduce his unconscious mental make-up and aspirations 
to an exact mathematical science. The yellow color in-: 
both dreams seemed to him to characterize the "yellow 
streak" in his character, — namely, the fear that he might not 
be able to honorably terminate the betrothal. The dream 
also meant to him a mathematical demonstration of lack 
of feeling for his betrothed. An analysis of the figures oc- 
curring in the two dreams demonstrated how complicated 

^For analyses of number dreams and the symbolism involved, see papers by 
Jung and Jones in the Zentralblatt f. Psychoanalyse (Vols. I and II), and also 
Steckel's Die Sprache des Traumes (Chapter XXXVIII). 



Isador H. Coriat 195 

may be the various manipulations of figures taking place 
in the unconscious and furnished an exact demonstration 
of the subject's mental conflict. This number symbolism 
was as follows: 

317= 3 + 1 +7= 11 

3990 = 39 + 9 + = 48 

48 + 11 = 59 (the age of the subject's mother). 

3 +9 + 9 + 0= 21 

3 t 1 +7= 11 

21 + 11= 32 (the age of the subject's fiancee). 

Thus the numbers were not accidental, but clearly 
revealed the struggle taking place in the unconscious. This 
struggle was symbolized by numbers, representing both 
the age of the subject's mother and of the subject's fiancee; 
in other words, the emotional conflict of the CEdipus-com- 
plex which produced the anxiety phenomena. 



ANAL EROTICISM AND CHARACTER' 

BY A. A. BRILL, PH.B., M.D. 

Clinical Assistant in Psychiatry and Neurology, Columbia 

University; Visiting Neurologist to Bronx Hospital 

and Dispensary 

IN his Three Contributions to the Sexual Theory, Freud^ 
shows that the sexual impulse in man consists of many 
components and partial impulses. Many essential 
contributions to the sexual excitement are furnished 
by the peripheral excitement of certain parts of the body, 
such as the genitals, mouth, anus, and bladder outlet, which 
we call erogenous zones. All these zones are active in in- 
fancy, but only some of them go to make up the sexual life. 
The others are deflected from the sexual aims and utilized 
for other purposes. This is the process of sublimation. 
During the sexual latency period — four to beginning of 
puberty, eleven — reaction formations, like shame, loathing, 
and morality, are formed in the psychic life of the individual 
at the cost of the excitements furnished by these erogenous 
zones, which act as dams for the later sexual activity. The 
anal zone is one of the components of the sexual impulse 
which, though active in infancy, falls into desuetude in the 
course of development, for our present cultural life does not 
use it for sexual purposes. It is the reaction formation of 
this zone that I shall here discuss. 

In the course of psychoanalysis we come across patients 
who tell us that it took them a long time to learn to control 
their bowels. These patients recall that even in the later 
years of childhood they occasionally met with an accident. 
When we investigate still further we find that they belonged 
to those infants who refused to empty their bowels when 
placed on the chamber because defecation caused them pleas- 
ure. A number of my patients clearly recalled that even 
in later years they obtained pleasure by withholding their 
movements, and that they took an unusual interest in their 

iRead before the American Psychoanalytic Society, Boston, May 28, 1912. 
"Translated by A. A. Brill, Nerv. and Ment. Dis. Monograph. 

196 



A. A. Brill * 197 

fecal excretions. This usually shows that their sexual con- 
stitution brought along an enhanced erogenous significance 
of the anal zone. As they grew older all these activities 
disappeared, and instead they manifested a triad of quali- 
ties which were described by Freud in his article on Char- 
acter and Anal Eroticism.^ 

To illustrate this character I shall cite the following 
case: 

X, forty-four years old, divorced, a very successful 
merchant, was referred to me for treatment by Dr. F. 
Peterson. The patient stated that his present illness dated 
back to his twentieth year. On examination it was found 
that he presented a typical compulsion neurosis,^ and that 
some of the compulsive ideas were as follows. When eating 
soup he would think it urine; when eating sausage he would 
have to think of feces. The noise of an auto horn made him 
think of a flatus or horse's flatus, on account of which he 
gave up automobile riding. On going to sleep he became 
obsessed by visions of people having movements of the 
bowels. A woman's mouth made him think of the rectum, 
her eyes recalled the anus. Shaking hands with a person 
recalled a man using toilet paper. Looking at big fat per- 
sons would obsess him with thoughts of their fecal excre- 
ments, the size, consistency, etc. A person with protruding 
teeth would recall feces protruding from the anus. The 
moon constantly recalled the rectum. 

These are only a few of the many dozens of similar 
compulsive ideas which forever obsessed him. Besides the 
obsessions he suffered from chronic constipation and from 
many other somatic disturbances. 

On hearing this voluminous skatological story I natu- 
rally thought of the anal eroticism, and the more I became 
acquainted with my patient the completer the picture became. 

Now Freud describes the persons showing the anal 
eroticism as being especially orderly, economical, and ob- 
stinate. Every one of these terms embraces a small group 
or series of allied characteristic features. Thus orderly in- 
cludes physical cleanliness as well as scrupulosity in little 

^Sammlung kleiner Schriften zur Neurosenlehre, p. 132. 

* Brill, Compulsion Neurosis, American Medicine, December, 1911. 



198 • Anal Eroticism and Character 

things; its opposite would be disorder and negligence. Econ- 
omy may shade into avariciousness; obstinacy may lead 
to spite and to a tendency for violence and revengeful acts. 
It is the last two — economy and obstinacy — that hang 
most firmly together, and are most constantly encountered, 
though the third is often found in the same person. 

X dressed and looked very neat and gentlemanly. He 
was very conventional, moved in very nice circles, and tried 
to make the impression that he was very particular about 
society matters. Thus, he often referred to his friend as 
not a gentleman because he would not always put on evening 
dress for theater. The slightest infraction of the general 
rule offended him. He lived in the best hotels and belonged 
to some very fine clubs. From his history I found that he 
was extremely self-willed and obstinate. He hated all his 
brothers because they claimed that he thought he knew it 
all, and he would give me many instances to show that he 
really was superior to them. This characteristic was not 
only apparent in his dealings with his family, but with 
every one else, including doctors. He consulted physicians 
in almost every principal city in the United States and 
abroad, and spoke disparagingly of all. He had also been a 
Christian Scientist and a New Thoughter, but as they did 
not benefit him he put them on the same level with the 
doctors. It was often very amusing to hear him speak of 
doctors I knew, and I have no doubt that I fare no better 
when he talks to others. His obstinacy and revenge led 
him to enter into commercial competition with his own 
brothers, and when his older brother implored his help and 
threatened to blow out his own brains because of financial 
ruin, he not only refused to assist him, but said to him, 
"Not a cent! Shoot yourself; do you remember how you 
treated me.^" (revenge and spite.) 

As an illustration of his financial dealings I shall cite 
an experience Ihad with him. As I said above he was Dr. 
Peterson's patient, and I first saw him in Dr. Peterson's 
office. He became unusually friendly, and as soon as an 
opportunity presented itself he proposed that if I charged 
him less for the treatment he would leave Dr. Peterson and 
come to me. I told him nicely that I could not think of 



J. A. Brill 199 

entertaining such a proposition, and that things would have to 
remain as they were. A few weeks later he saw Dr. Peterson, 
unknown to me, and told him that he was poor and unable 
to continue with the treatment unless his fees were reduced. 
Dr. Peterson, not knowing the true circumstances, reduced 
his fee fifty per cent. That same week he invested many 
thousands in a new business venture in New York City. 
More than this, when his bill was sent to him at the end of 
the month he sent a check for about one-tenth of the amount 
on account. It is now about two years since the treatment 
ceased and he still sends us small amounts from time to 
time. I may here mention that he is a very wealthy man 
and owns large interests in a number of big commercial 
houses. His dealings with other people were of a similar 
nature. Thus, I prescribed some medicine for him and 
he then complained that the druggist was a highway robber. 
He lost the friendship of many people because of his stingi- 
ness. I have this from his own account. In fine, he was 
what people would call a miser, though to all appearances he 
looked like a generous gentleman. As a business man he 
was a great success because, as he said, "I knew how to 
manage things, and I could always be relied upon." 

The extreme neatness, orderliness, and reliability in 
our patient are nothing but reaction formations against the 
interest in the not neat or dirty which is not a part of the 
body. 

During the analysis I found that as a child the patient 
had a hard time to control his rectum. He was punished 
and jeered for regularly soiling himself up to his sixth year. 
At nine years he was sent home from school in dis- 
grace because he broke wind in the classroom. This 
was recalled under marked emotivity. He stated that it 
was a mixed class of boys and girls, which made it still 
harder to bear. The following year he met with another 
accident while following a parade. He received a rather 
severe spanking for it because he had on a new white suit. 
The patient also recalled that as early as in his fifth year 
he had the habit of sticking his finger into his rectum, a 
habit which he continued for years. 

Whether he was one of those infants who hold back 



200 Anal Eroticism and Character 

their stools I could not discover, but as far as his memory 
reached there was an extreme interest for feces and for the 
gluteal region. 

It is not simple to connect the interest in defecation 
with obstinacy, but we must remember that even infants 
can be self-willed when put on the chamber, and that painful 
irritations of the skin connected with the anal zone (spank- 
ing) are utilized to break the child's obstinacy. We all 
know that when people wish to express spite or spiteful 
mocking they invite people to kiss their behind, which points 
to a repressed pleasure. As a child our patient was very 
often spanked, not only by his parents but by his older 
brother. One incident which he especially remembered 
was a very brutal treatment by his older brother. 

The relation between defecation and money, though 
seemingly remote, still shows a definite connection. Some 
of you know that the most obstinate cases of constipation 
can be cured by psychoanalysis. Of course they can also 
be cured by other means, such as hypnotism, but by psy- 
choanalysis they can be cured only after the money complex 
of the patient has been thoroughly thrashed out and brought 
to consciousness. We know that misers are called filthy 
(filthy lucre), and that in mythology, fairy tales, super- 
stitions, and dreams, money is intimately connected with 
feces (goose that lays the golden egg). In the old Baby- 
lonian teachings gold is the dung of hell.^ It is also probable 
that the contrast between the most valuable that man has 
learned to know, and the least valuable which he ejects 
as refuse, has formed the identification. This identification 
is also strengthened by the fact that when the erotic interest 
in defecation ceases the interest in money begins which was 
lacking during childhood. The yellow color which is com- 
mon to gold and feces probably forms another association. 

It may also be mentioned that the triad of qualities 
are not found in those persons who retain the anus as an 
erogenous zone; e. g., homosexual pederasts. Those whom 
I know are all very generous indeed. The treatment of 
X had to be stopped on account of his money complex at the 
end of about two months, although he admitted that he was 

^ Freud, Anal. Erotic, 1. c. 



A. A, Brill 201 

much benefited by the analysis. When he first came for 
treatment he was so annoyed' by the obsession caused by 
the noise of auto horns that he promised me seventy-five per 
cent of his income if I rid him of it. After a few weeks' 
analysis this and some other obsessions were removed, he 
was very pleased and surprised, he thought it was miraculous, 
but notwithstanding all this it was impossible for him to 
pay a moderate fee for his treatment. As far as I have gone 
the analysis showed an accentuation of the anal zone in 
infancy, a retarded repression with its reaction formation, 
as shown by his character, and then a failure of the repression 
at the age of twenty years with a negative revival of the 
anal activity in the form of the skatological obsessions. 

Case II. — H., thirty years old, suflFered for years from 
a compulsion neurosis which manifested itself in obsessions, 
doubts, and phobias. To save time I shall merely state 
that he soiled himself to the age of eight years, and from his 
mother's account he was almost never free from bowel 
trouble until the age of five years. The neurosis mani- 
fested itself at fifteen years, and besides many obsessive 
thoughts he was also troubled by an obsessive act. He 
could not resist the impulse to rub his feces on walls, and at 
times on his body. H. stated that he had the habit of hold- 
ing back his bowels because it gave him a distinct feeling of 
pleasure and stimulated his mental activity. Whenever he 
was confronted with a difficult task he "practiced consti- 
pation." As an example he gave the following episode: 
As a reporter for a newspaper he was sent to observe and 
report the maneuvers of the National Guard. He was very 
anxious to write nice reports, ^nd to accomplish this he would 
hold back his movements, for two to three days until- it 
became almost unbearable, and he would then imagine 
himself on the battlefield of Waterloo and describe what he 
saw. Here, too, the anal activities were the result of a 
failure in the repression af an enhanced zone. 

But it often happens that in addition to an erogenous 
zone there is also a revival of one or more of the partial 
impulses. Whenever this occurs the symptoms usually 
show a corresponding combination. The following will 
serve as an illustration. 



202 Anal Eroticism and Character 

Case III. — B., thirty-nine years old, suffered from a 
compulsion neurosis. He was obsessed with doubts and 
phobias which referred to definite ideas about people being 
killed. It would be impossible to give here a description 
of this very interesting case, which I hope to report in full 
at some future date. I simply wish to state that he, too, 
showed an enhanced anal activity in infantile life, although 
not nearly as marked as in the other cases. But the most 
prominent factor in his infantile sexuality was the component 
of cruelty. B. was taught to use firearms at a very early age. 
His greatest pleasure up to the age of nine to ten years was 
shooting birds, squirrels, and rabbits. At the age of puberty 
he became very sympathetic, and one day after shooting a 
squirrel he suddenly experienced feelings of compassion and 
remorse. Since then he found it very hard to go out shoot- 
ing. When his neurosis developed at the age of eighteen 
years he also began to suffer from constipation, which con- 
tinued ever since for fifteen years. No medication would 
relieve him until he accidentally discovered that the following 
process gave him a movement of the bowels. He once 
played with a spool of cotton upon which was a picture of a 
child. He rolled it and when the child's picture came his 
way he stuck a pin into it. After five minutes of such play 
he would have a movement. He then resorted to this 
practice, which he modified from time to time until he was 
cured. He carried a number of long pins which he sharpened 
from time to time, and every morning he drew a picture of 
a girl and thrust the pins into the region of the heart. 
When he was very busy he would simply draw a target on 
paper and throw his pen at it, imagining that it was a girl. 
As the years went by he resorted to many other variati ns. 
Thus when he lived in the country he would shoulder his 
rifle and go out into the garden, and by imagining that he 
was shooting Indians his bowels were soon stimulated to 
activity. Sometimes he imagined himself fighting, which 
gave the same result. On one occasion while throwing his 
pins at a picture one of them fell through the window into 
the garden, and as children were wont to play there, he soon 
became obsessed with the idea that one of the children 
might swallow the pin and die. This was the first obsession 
of this kind which continued in different forms. 



A. A. Brill 203 

All these patients showed a special interest in their 
anal activities in childhood and in adult life. Later when the . 
infantile activities of the anal zone remained in a state of 
repression they belonged to that class of persons who prolong 
the act of defecation by reading books and newspapers in 
the water-closet; thus X referred to the water-closet as his 
library. With the onset of the neurosis which signifies a 
failure of repression, the originally enhanced anal activities 
came to the surface in the form of symptoms; i. e., the neu- 
rosis represented the negative of the perversion. 

The analyses of these as well as of a number of other 
cases fully corroborate Freud's formula; viz., that the perma- 
nent distinguishing traits of a person, are either unchanged 
continuations of the original impulses, sublimations of the 
same, or reactions formed against them. 



REPORT OF A CASE OF VERSUCHUNG ANGST 
ATTENDED BY VISUAL HALLUCINATIONS 
OF A HOMICIDAL NATURE^ 

BY G. A. YOUNG, M.D., OMAHA, NEBRASKA 

IN 1904 Warda described a type of obsessions which he 
sought to specify by giving it a name of Versuchung 
Angst, and postulated its origin in a constitutional 
tendency to anxiety states. The type as outlined by 
Warda is characterized by distressing ideas of violence, 
sacrilege, or obscenity in marked contrasts to the apparent 
nature of the patient. 

Skliar, in 1910, has cited eight cases of a similar nature, 
and deprecates their segregation as a clinical entity on the 
ground that such cases show no essential difference from 
other forms of imperative ideas. Freud, in his recent 
"Remarks upon a Case of Obsessions," states it would be 
more correct to use the term zwangdenken rather than 
zwangvorstellungen — imperative thinking instead of impera- 
tive ideas. 

Although the scope of the paper prevents justice being 
done to the material obtained by the analysis, the case here 
reported seemed worth recording from several points of 
view. First, the symptomatology of the case is striking, 
and the symbolism of the hallucinations is closely associated 
with the CEdipus-complex that underlies the whole clinical 
picture. Second, the disease can be considered as the 
culmination of a character development which can be traced 
from early childhood. Third, there is a striking resemblance 
between the hallucinations here experienced and the Angst 
dreams of the neurotic. Fourth, the content of the phenom- 
ena related stand in associative connection with the sexual 
phantasies of the child towards his mother. Fifth, the 
causal relation of these phantasies to the development of a 
masochistic and homosexual inclination as a defense re- 
action was clearly shown. 

In the paper none of these points can be developed at 
any length, and only the main features will be noted. The 

1 Paper read at the Annual Meeting of the Psychoanalytical Association^ 
Boston, May, 1912. 

204 



G. A. Young 205 

patient, a male, age twenty-two, intelligent and of common 
school education, came to the writer in August, 1910. He 
had been treated for neurasthenia for four months, but had 
told no one of the real nature of his trouble for fear he would 
be adjudged insane. In a hesitating, fearful manner he 
told about having uncontrollable thoughts and visions of 
violence and murder for the past four months, in which he 
would see himself killing his mother and sister. These 
thoughts, and fears that he would be forced to carry out 
these visions, were of such a depressing nature that he said 
he could neither rest nor sleep, and that unless he obtained 
relief he felt that he must carry out the thoughts of suicide 
that so frequently came to him. He felt weak, had lost 
weight, and though six feet three inches in height, weighed 
but one hundred and fifty pounds. He realized the visions 
were not real, though they came with the vividness and 
intensity of reality. Not only were his waking moments 
filled with impulses to violence, but his dreams were of the 
same character and he frequently awoke in distressing 
nightmares. 

The physical examination of the patient was negative. 
His general attitude was deprecating and shy, his posture 
stooping, and his walk had a peculiar tiptoe-like tread. The 
facial expression was depressed, and his eyes,, hollow and 
surrounded by dark circles, had the gloomy, anxious, and 
fixed gaze so characteristic of the severe depressions. He 
was well oriented and in no sense seemed to have lost hold 
of reality. 

His father and mother were both living and healthy. 
Two maternal aunts had suffered from attacks of depression, 
but both had been well for years. The mother was emo- 
tional. The patient was the youngest of the family, which 
consisted of seven brothers and one sister, the girl being the 
next oldest to the patient. The brothers had been away from 
home several years and he and his sister, of whom he was 
very fond, had supported the two parents for the past four 
years. 

From the age of five he had always been of an anxious 
and sensitive temperament, and has been much inclined to 
stay at home. Before the age of five he was said to have 



206 Report of a Case of Versuchung Angst 

been bright and free from fears and learned readily, but 
after five he became timid and fearful and, in his own words, 
full of conflicts. 

At the age of nine he had an attack of depression lasting 
six weeks in which he cried a great deal, and, as he expressed 
it, could not get any fun out of life. At the age of twelve, 
after a few days of depression, he had a sudden impulse to 
strike his sister from behind with a hoe, and for three months 
after the impulse to strike his sister and mother with a 
hatchet, axe, or hoe were very frequent. His depression and 
sense of self-blame were very intense at this time. From 
this age to the outbreak of his trouble in 1910 he remained 
well and, on the whole, was of a fairly happy, though sensi- 
tive and retiring disposition. He was especially noted for 
his consideration and care of his mother and sister. 

In October, 1909, his sister had become engaged and 
had intended marrying at Christmas. He was very de- 
pressed at the thought of losing his sister. He did not want 
her to marry and had her postpone the wedding until the 
following June, as then he could get a vacation and go with 
her on her wedding trip. In November, 1909, he began 
correspondence with-a young woman in a distant town whom 
he had not seen for three years. He did this with the inten- 
tions of becoming engaged to her. 

From January, 1910, on until the appearance of his 
violent thoughts he had been increasingly depressed and 
absent minded, and had found it difficult to perform his 
duties in the store. In February, after a day or so of feeling 
unusually well, he suddenly had the thought, "what if my 
parents should die." The thought came as a shock and 
he felt grief and fear at the prospect; that life would not be 
worth living without them. 

On May 18, 1910, while seated at the piano playing, 
he saw his sister through the window across the street. The 
idea of shooting his sister with a revolver suddenly came to 
him and with it the fear that he might shoot her. The next 
evening after dark he went out walking with his sister, and 
as they were passing under some trees, the phrase, "in a 
dark lane," came to him, and with it the thought of killing 
her. The day after, in the basement of the store, he saw a 



G. A, Young 207 

coffin standing at an angle of forty-five degrees, and his 
mother in it, and the thought of killing his mother seemed to 
strike him like a blow. 

Following the vision of his mother's corpse in the base- 
ment, homicidal fancies of killing his mother became in- 
creasingly frequent and insistent, and his visions of death 
and acts of violence became more and more terrifying. His 
depression was intense, and by the latter part of May he 
was forced to discontinue his work. He remained at home 
until the end cf June, when he left, as he felt he could no 
longer be sure of himself. His sister had married, and his 
visions concerned his mother almost entirel}^. There were 
no ideas of violence toward his father or toward others than 
his mother until he left home, when visions of violence 
toward his brothers and his female cousins, with whom he 
stayed, came to the surface. The idea that he was insane 
preyed upon him and the thought of suicide was never far 
absent. 

From the time he left home, the last of June, to the last 
of August when he came under my care, his visions remained 
unchanged. The description of some of the visions w^hich 
follows is taken partly from the notes made during the 
analysis and in part is quoted direct from his own description* 
written during the analysis. 

During the early part of June the patient was standing 
by the pump and saw an axe near by. He put his foot on it 
and then saw a woman standing close at hand with a long 
bleeding gash on her neck. He said to himself, "that can't 
be my mother," and at this moment his mother appeared 
beside the other woman but without a wound. At the same 
time he saw a man in blue overalls going around a corner 
of the house. 

Once he was standing near the barn and his mother 
was not far off. Of a sudden he saw a lathing hatchet fly 
by and strike his mother on the head, and at the same time 
he saw another pass near his hips and strike the barn.. He 
heard the sound of the blow and then for a moment saw the 
cut of the hatchet in the wood. 

While lying in bed in the house, in May, an arm and 
hand carrying a knife of a peculiar shape appeared to him 



208 Report oj a Case of Versuchu7ig Angst 

as his mother came in the room and near by the knife floated 
a purplish heart. 

For further descriptions of the visions allow me to quote 
from the patient's own statements. These were written while 
the patient was in full Ubertragung, or state of transfer, 
and some of the visions naturally concerned the writer. 

"A vision of a coffin with a cardboard on it with this 

inscription, 'waiting for '; a vision of a butcher knife, 

and following it the sight of a naked woman; a vision of my 
mother under a waterfall dead, and over the water a plug of 
horseshoe chewing tobacco. This last vision followed the 
thought, 'if my mother were dead I could get married.'" 
(The recollection of this idea came two months after be- 
ginning treatment.) "A vision of a hammer lying near 
mother which went to tapping her upon the head. Then 
there seemed to be an expression in my head not to give up 
this idea until it was carried out; a vision of my mother 
sitting in a chair and my walking up and shooting her. 
Again I was pictured standing up in one room and my 
mother kneeling in the other, and I was shooting her through 
the door. The next was seeing my mother's neck cut and 
bloody water coming from the wound. One Sunday I was 
afraid to stay alone with mother for fear after every one was 
gone I might kill her. Then one Sunday I thought she was 
coming home alone from church and I would be alone with 
her, but it was a female cousin and I thought, 'what a narrow 
escape.' Then a vision of seeing my mother in a barrel of 
brine in a meat market. A vision of seeing Dr. Young and 
myself lying in a street near a ditch that had been freshly 
dug, I lying with my arm across his body. Another scene 
of the doctor being carried in on a cot with a netting spread 
over him. A vision of the doctor and myself in the act of 
murdering my mother, she lying limp in my arms, and of my 
going to throw her in the river; vision of myself jumping 
out of a window or off a bridge, and the feeling of relief 
accompanying the act. At times I feel like sticking my 
head into a wagon wheel or under the wheel of a street car. 
I was afraid I would murder the nurse by throwing a rod at 
her endways." (At the hospital he was afraid these assaults 
on the nurses would take place at one thirty, and was afraid to 



G. A. Young 209 

look at the clock for fear he would find the hands at this posi- 
tion. This fear left him after the analysis of a hat and clover 
leaf dream wherein he saw a hat stuck full of individual clover 
leaves. In the analysis the associations with the clover 
leaf and the hat led to the symbolism of numbers. The 
numbers three and one became clear to him as phallic sym- 
bols, and the hat as symbolic of the vagina. No mention 
that day was made of the one thirty phobia. The next 
morning the first thing he said was that he no longer feared 
to look at the clock. The number one thirty represented a 
coitus in which the one stood for the penis, the two curves 
of the three for the testicles and the zero for the vagina.) 

"Again I had a vision of seeing Dr. Young lying on the 
grass surrounded by fire and I jumping into the fire with 
him. Another vision of Dr. Young and myself bound to the 
tops of two telephone posts which were connected by tele- 
phone wires." The symbolic nature of these later visions 
regarding me as erotic homosexual phantasies can hardly be 
doubted. 

The subjective aspect of the patient's mental condition 
is admirably related in a further statement: "My brain 
feels at times like a rubber balloon which has been filled 
with air. It feels as though I don't want to know anything 
and don't want any one to tell me anything. And when 
I think of sticking any one with a knife, the expression seems 
to come from the top of my head and passes down over my 
forehead with a quick heavy dull feeling, causing the feeling 
of self-blame, stupidity, distress, and hate for every earthly 
thing, and often ends with a feeling of wanting to live con- 
tinually in a wretched state of anguish. As I look on these 
thoughts the feeling reminds me of a spring attached to a 
screen door which is constantly pulling on the door. These 
thoughts in my brain seem like undigested food in one's 
stomach. The brain does not seem able to digest them, they 
keep coming in automatically and have no pleasant meaning 
to them." 

The dreams of the patient were of the same painful and 
distressing nature as his symptoms. Upon his first visit 
the first dream he related was typical and indicative of the 
central nucleus of his neurosis. Not until two weeks later 



210 Report of a Case of Versuchung Angst 

did I learn that it was a nightmare experienced at the age 
of six years and instinctively given the importance it de- 
served by being first related. He related dreaming of his 
mother seated outdoors in her nightgown with shoulders 
bare. His maternal uncle was carving flesh from her shoul- 
der and face with a butcher knife. He noticed in particular 
the stiff, ankylosed forefinger of the uncle extending along the 
knife. The father was standing near by apparently un- 
moved, and the mother also seemed to take the proceedings 
as a matter of course. The patient stated that he experi- 
enced great horror at the sight and woke up terrified. The 
dream was undoubtedly symbolic of the parental coitus. 
The uncle in the dream probably had a triple determination: 
first, through a decomposition of the father image as in 
myth production; second, the ankylosed finger (a phallic 
symbol), of which as a child he had a lively horror, together 
with a strong feeling of hate for the uncle; and thirdly, as a 
possible representation of the brother-sister complex as 
existent in his own relation with his sister. Another night- 
mare was one in which he was fighting a bull with a knife; 
as he fought he saw his mother in the distance and started 
toward her with knife in hand. Then he had a sickening 
feeling and awoke in distress. During the third month of 
his treatment there came to consciousness, childhood phan- 
tasies in which the male sexual organ was looked upon as a 
sharp instrument, such as a knife or spear, which could 
penetrate the body anywhere. The knife then seems here 
not only to denote feelings of violence and hate, but is also 
the medium of expression for childhood erotic phantasies 
directed toward the mother. 

A third dream, occurring on the sixth day of the analysis, 
ran as follows : He was near his old farm home in the cattle 
country, he saw five wild, angry Texas steers running toward 
him. Greatly frightened, he ran to the house door for pro- 
tection. His mother was there. As he reached the door 
he looked around and saw the steers passing by and his 
father driving them on horseback. Back of his father came 
five mild, peaceful sheep, which trailed quietly along and 
gave him a sense of safety. 

The associations with the elements of the dream con- 



G. A. Young 211 

tained memories of some of the most important events and 
impressions of his childhood. His father and mother were 
of different natures. His father was strong and choleric in 
temperament, his mother mild and easily moved to tears. 
His father had been a cavalryman in the Civil War, and the 
patient in his earliest recollections related the effect of the 
war stories upon his imagination, of his shrinking from having 
them told; not only because the stories of violence hurt him 
and made him afraid, but because he was forced to think of 
the narrow escapes his father had from being killed. The 
thought of what would have become of him had his father 
been killed troubled him greatly. Even then the fancies of 
his father's death and also of his own, together with ques- 
tions of the origin of his life and of eternity, were often in 
his mind. The death of one or both of his parents was pres- 
ent in his phantasies early in life and recurred at intervals 
up to the time of his recent trouble. At the age of eight, one 
night when his mother spoke to him impatiently, he said to 
himself, "I wish she were dead," and at once felt great re- 
morse and cried far into the night over his wickedness. At 
times he would have fancies of a man who killed people, and 
how if the person came to him and said he would have to 
kill one of his parents, what a trouble he, the patient, would 
have deciding which parent should die. Then would come 
fancies of a fool killer and a thought that he would get killed. 
The phantasies of the death of one or the other of his parents 
expressed conflicting feelings of love and hate which existed 
in our patient's psyche towards each of his parents. 

In this patient there was depicted in a striking manner 
the projection of his dissociated bisexuality upon the persons 
of his parents in such a way that his mother personified his 
homosexual and masochistic proclivities; his father, his 
heterosexual and sadistic impulses. By this mechanism his 
behavior and feelings toward his parents expressed essentially 
his own attitude toward himself, toward the impulses arising 
respectively from the heterosexual and homosexual com- 
ponents of his libido. This determination of the child's atti- 
tude to his parents seems very common, and I have met it 
clearly expressed in several cases of pronounced psycho- 
neuroses. 



212 Report of a Case o] Versuchung Angst 

The Texas steers were very familiar to the patient as 
a child, and expressed the untamed and violent nature of 
his early sadistic fancies. He was fond of speaking of him- 
self as a relic of the stone age wherein men fought for their 
wives and dragged them by the hair. The contrast be- 
tween the steers and the sheep not only represented the 
contrast between his father and mother, but also between 
his own emotional attitude at the time of his attacks at the 
age of twenty-two and twelve respectively, wherein the 
sadistic impulse prevailed, and that of his habitual mild, 
reserved, and rather fearful temperament. 

The numbers of the dream, two fives, brought the 
associations of his family numbering ten, and his two hands, 
with their five fingers, another determination of the dream 
as representing the two sides of his nature. The running 
to the house was later found to have relation to the common 
phantasy of intrauterine life, of return to the mother's 
womb, a phantasy which was recalled to consciousness. It 
is essentially this identification with the mother that is 
associated with the development of the homosexual com- 
ponent of the libido. 

The associations with regard to the hands were very 
interesting and can be used as further confirmation of Dr. 
Pierce Clark's observations of the use among imbeciles of 
the. hands and fingers as erogenous zones. The patient 
since childhood had had the habit of sucking all the fingers 
of his hands, and also of closing the tips of his fingers to- 
gether so that the little finger stood out like a teat. While 
under treatment he had a dream of a gnomelike creature 
jumping out of the fire box of a traction engine, with its 
mouth and finger tips aflame. Fire in such dreams seems to 
be symbolic of erotic pleasure. 

The patient was under my care for six months, and from 
the first showed slow but steady improvement in his emo- 
tional reaction. The visions did not entirely cease until well 
into the fifth month, though they steadily decreased in fre- 
quency. At the end of the sixth month he went home with 
an increase of twenty-five pounds in weight and with an 
active desire to get into work again. He had lost the sense 
of intense depression and only occasionally spoke of a slight 



G. A. Young 215 

feeling of tightness in his head. He has been at home now 
fifteen months and reports at the present time he is feeHng 
very well. It might not be wise to speak of complete re- 
covery, as these cases without analysis are noted for their 
tendency to remission. Still his brothers state that he seems 
to be a different individual. He is more assertive and 
aggressive, and takes pleasure in social activities with the 
younger men in a way he had not done before. The writer 
is conscious of an incomplete analysis and expects to see the 
patient again this coming autumn for further study. 

The main elements of the analysis that seem to stand 
out conspicuously can be shortly summarized as follows: 

A precocious sexuality in a sensitive and imaginative 
child. Appearance of anxiety or fear states at the early 
age of five. This precocious sexuality and the early ap- 
pearance of fear states seem to go hand in hand with the 
development of what the writer describes as positive and 
negative sexual phantasies and impulses, the one corre- 
sponding to the expression and the other to the repression 
of the childhood erotic impulse. 

Among some of the data out of sexual anamnesis the 
following can be cited : Before the age of five he had been 
told by his mother that God had sent him down from heaven. 
He cherished this idea, and was very angry at his mother 
and shocked when his brothers laughingly told him when 
he was five years old that he was made by his father and 
mother in the same way the animals were. He was much 
troubled by erections at the age of five, and thought they were 
wrong. At age of six used frequently to play at coitus with 
a boy cousin. At that time thought of coitus as a posteriori. 
From six or seven was addicted to various masturbatory 
practices. At seven played coitus with a large doll which 
he wrapped in his mother's skirt. Recollections of dreams 
at that age of his mother having coitus with neighbors on the 
same bed on which he imitated coitus with the doll. 

At ten years of age he had hermaphroditic fancies of a 
double set of sexual organs which would furnish him added 
pleasure. Slept with his sister at age of eight and then re- 
fused to sleep with her because his boy friends accused him 
of coitus with her. Various other incidents and phantasies 



214 Report of a Case of Versuchung Angst 

relating to this sister showed marked sexual coloring. At 
seven and eight years used to dress as a girl and used to be 
jealous of his sister when boys would come about. Mastur- 
bation began at fourteen and practically ceased at seven- 
teen. During these times he would have spontaneous 
erections and emissions. Engaged to a girl at the age of 
fourteen. It was a passionate but idealistic love affair. 

The negative aspect of his sexuality showed itself in the 
following reactions, which, in the main, were still present at 
the beginning of the analysis and which disappeared during 
its progress. 

The horror of his uncle's stiff finger has already been 
mentioned. The same horror was felt for the mucous mem- 
brane of the empty eye socket of an old lady neighbor. At 
age of six and up, nausea and disgust at the sight of the 
breeding of animals, at the sight of the birth of a calf, and 
the mother licking the calf and eating the placental mem- 
branes. Vomiting at the sight of the birth of pigs covered 
with membrane. Could not eat pigs' feet, oysters, soft- 
boiled eggs, or drink milk that had a skim on top as when 
heated. From seven on, very clean about his face and 
clothes and personal habits. At from twelve to sixteen 
thought coitus so bad that he wished to die. At this time 
he had fancies of self-castration, fancies which were clearly 
represented in visions and impulses of his later neurosis. 
At sixteen he ate some dirt and following the act had a fear 
that he had eaten excrement. The origin of a number of 
these symptoms in autoerotic, coprophilic wishes is further 
substantiated by visions that he had of himself during his 
illness of being in the manhole of a sewer and eating sewage. 

These sexual repressions were aided and complicated by 
a narrow religious teaching that served only to intensify his 
fears and self-accusations. This teaching and the idea of 
God that it gave him were brought by the child into as- 
sociation with the surrounding hard conditions of poverty 
and isolation under which the family lived. His early years 
were times of drought and tornadoes wherein nature rarely 
seemed to be in a kindly mood. He remembered praying 
for rain at the age of four, and saying there was no God 
because no rain came and the crops failed. The reading 



G. A. Young 215 

of elements of hostility into these surroundings naturally 
followed and feelings of rebellion and hate in answer to this 
hostility accentuated his conflicts. This environment by 
reason of its isolation, poverty, religious narrowness, and 
intolerance undoubtedly tended to inhibit the development 
of the patient's individuality and predisposed to a life of 
phantasy. 

Incestuous phantasies regarding his mother and sister 
were found. Knives, hatchets, and gun were used as phallic 
symbols. In the analysis he recovered phantasies of child- 
hood in which the male sexual organ was represented as a 
sharp instrument which could enter the body anywhere. 
The devil with his spear-shaped tail was an object of fear 
early in life, and he used to think the devil carried off his 
victims by spearing them through the navel. 

It is important to note that the outbreak of symptoms 
followed the engagement of his sister. The withdrawal of a 
real object of love is one of the prerequisites for the mechan- 
ism of regression to unconscious and infantile phantasies 
of love. He endeavored to compensate for the loss of his 
sister by becoming engaged to a girl he had not met for 
three years, but here I believe the unconscious fixation of 
his love on his mother interfered and prevented a normal 
breaking away from his family. 

Strong homosexual phantasies existed, having his father 
primarily as the object, but which, secondarily, were based 
upon homosexual experiences with his boyhood friends. At 
the time of the attack, at the age of twelve, he had definite 
love fancies with regard to boys, and considered the feminine 
sex as superfluous. He was jealous of his sister when boys 
came around. Possibly we have here another determination 
of the fancies of violence toward his mother and sister. The 
fancies of assault may then be looked upon not only as dis- 
guised heterosexual and sadistic impulses toward his mother, 
but also as symptoms of a hate which had its deepest source 
in the homosexual trends of the patient. 

Fancies of hate since childhood towards his mother as 
an obstacle to his pleasure which are epitomized in the 
sentence, "If my mother were dead I could get married." 
In early life his brothers had teased him by saying that by 



216 Report of a Case of Versuchung Angst 

being the youngest he would have to stay at home and look 
after his mother while the rest of the family could get 
married and go away. This thought used to make him 
furiously resentful. 

The writer is deeply conscious of the deficiencies of a 
short report such as this which leaves out so much of the 
important material of the analysis that brings to the mind 
of the physician, as well as the patient, a conviction of the 
mechanisms and forces at work in the production of symp- 
toms such as were experienced by this patient. The fault 
is not his, but is inherent in the time conditions of this 
meeting and in the volume of material involved. 



ABSTRACTS 

REMARKS UPON PSYCHOGENETIC CONVULSIONS AND GENUINE 

EPILEPSY. 1 L. Pierce Clark, M.D., New York. 

The author pointed out that although epilepsy was an organic 
disease with either macroscopic or microscopic changes in the 
cortical elements, the clinical expression of the disorder was still 
frequently confounded with convulsion episodes of purely psycho- 
genic origin. Frequently the two disorders exist in the same case; 
the two disorders were not mutually. exclusive. He urged a fuller 
detailed analysis of all the fit types and not to be satisfied with the 
crude designations of grand mal, petit mal, and psychic seizures 
of so-called genuine epilepsy. He believed that almost all the so- 
called psychic epilepsies were psychogenic in character and capable 
of being controlled or removed by Freudian analysis. Post- 
epileptic automatism and the manic periods were to be better 
explained on a basis of a dream state in which a wish fulfillment 
was the motive or ruling idea. The fact was illustrated by citation 
of cases. Psychoneurotic individuals may not only have aura in 
their psychic episodes like genuine epilepsy, but they may fall and 
injure themsleves and in exceptional instances even pass urine, 
bite the tongue and lips, and lose consciousness. Psychoneurotic 
epilepsies are difi'erentiated from the truly epileptic in character, 
in that the former are disorders of association of ideas, have great 
constancy, often prevented by hypnosis and often displaced or 
prevented by purely psychic treatment, and in the majority of 
instances uninfluenced by sedatives. Amnesic periods are purely 
functional in character and intelligence tests reveal no real mental 
impairment as in that of the genuine disease. In his experience 
in the association state, epilepsy and psychogenic episodes, the 
latter are not so permanently or completely removed as in the 
uncomplicated psychoneuroses. The sexual element is not so 
dominant or marked. For two years he has submitted all his 
epileptics to psychoanalysis with considerable success, especially 
affording satisfactory results as an accessory to the so-called 
hygienic treatment of epilepsy. Again, too, the cured or arrested 
cases are aided in conserving their energies and given a better 
outlook on life. The author believes that the epileptic has a 
characteristic constitutional make-up which is independent of the 

' Read before the American Psychopathological Association, Boston, May 29, 
1912. 

217 



218 The Journal of Abnormal Psychology 

deterioration characteristics of the established disease, and would 
particularly ask clinicians to make their diagnosis and prognosis 
on the intensity of this state rather than upon any peculiarity 
of the convulsive phenomena themselves. He entered a special 
plea for the broadest biologic conception of the epilepsies as well 
as the psychoneuroses resembling the former. 

Author's Abstract. 



INVESTIGATIONS OF. A THOUGHT-READER. {U ntersuchuugen 

eines Gedankenlesers.) R. Sommer. Klinik f. psychische u. nervbse 
Krankheiten. 1911. Band VI. Heft 4. S. 339. 

Sommer urges that the only means of diminishing the present 
popular belief in the mystical, superstitious, and supernatural 
aspects of certain occurrences is properly to investigate them by 
psychological methods instead of ignoring them as is so commonly 
done in the scientific world. He here describes a series of ex- 
periments carried out with a well-known public thought-reader, 
who advertised himself as "a telepathic phenomenon" and "the 
unsolved riddle of all physicians and psychologists." The experi- 
ments are related in full detail, with also an account of the exact 
conditions under which they took place. The limitations imposed 
by the man himself were that the person whose thoughts had to 
be read should be in the actual room, that these should consist of 
energetic commands, and that a third person who was to be aware 
of them should be in contact with him. Six tasks were set, all of 
which were correctly performed. Before carrying them out, 
however, a number of curious mistakes were made, in the manner 
of tentative attempts. It was clear that the "thought-reader" 
had no idea at the outset, as to what he had to do, or when he had 
finished his task. It was shown that he proceeded tentatively, 
from one step to the immediate next one, as is always the case in 
"muscle-reading," and that there was no question of reading 
what was in the mind of the man leading him. His mental state 
was one of unusually intense concentration, but of full conscious- 
ness. Not the slightest evidence of any telepathic capacity was 
to be found, and the only difference between the "thought-reader" 
and the normal average person was an extraordinarily developed 
sensitiveness for the perception of fine involuntary movements 
(on the part of the person guiding him, who had to think hard 
about the task to be performed). In other words, the phenomena 
were those of the well-known muscle-reading (or pulse-reading), 
which have been often exploited before the public by numerous 



Abstracts 219 

professionals like Bishop and Cumberland and in the production 
of which skill is easily acquired even by amateurs. 

Ernest Jones. 



r 



STUDIES OF THE GENESIS OF THE CRAMP OF WRITERS AND 
TELEGRAPHERS. THE RELATION OF THE DISORDER TO OTHER 

neuroses: their pathogenesis compared WITH THAT OF TICS 
AND HABIT SPASMS: DESCRIPTION OF THE TREATMENT MADE 

POSSIBLE BY THIS RESEARCH: CASES. Tom A. WUHams, 
M.B.C.M. Jour. f. Psychol, u. Neurol. (Leipzig.) 1912. 

It is not surprising that writers' cramp, as it is called, is the 
commonest occupation neurosis because writing is the most wide- 
spread manual art which exacts the frequent repetition of the same 
movements. Thus, of the five cases, four are writers. 

But the differences of pathogenesis cannot be expressed in terms 
of the kind of handicraft affected. To express them in terms of 
muscle function or topography is also misleading as the analyses 
of the cases clearly show; nor is cerebral locality, nor even 
perhaps functional "center," a fruitful explanation. 

The mechanism of professional cramp is always psychological.* 
Accordingly the treatment must address itself to the psyche. It 
must be clearly understood that the disorder of the apparatus is 
not structural but regulative. It is not an incapacity of muscle 
and nerves to perform their function; for this is intact except for 
performing the particular professional acts which fail. A want 
of harmony in the controlling of the mechanism is the fault We 
have not even to deal with the kind of want of harmony which 
occurs upon the destruction or toxic inhibition of the cortical center 
such as happens in aphasia. Professional cramp is a strictly 
psychodynamic inhibition or disorder in the habitual series of 
co-ordinated associations gained by education in some art. 

The paper consists of an analysis and account of the treat- 
ment of four cases, and a discussion of the principles accruing from 
the research. 

Author's Abstract. 



REVIEWS 

THE EVOLUTION OF MIND. Joseph McCabe. London. Adam 
& Charles Black. 1910. Pp. xvii, 287. 

THE MIND OF PRIMITIVE MAN. Ffunz Boas. Ncw York. 
The Macmillan Company. 1911. Pp. xi, 294. 

These two recent books, not less interesting than important 
to every student of mental process, logically form a continuum, 
the latter taking up the mental evolution about where the former 
leaves it. Both are composed in the broad and far-seeing spirit 
of the truly understanding mind, but while Fr. McCabe shapes 
his whole book's argument to convince one of the continuity and 
essential likeness of mentation from alga to man. Professor Boas 
of Columbia emphasizes the same thing in the species of Homo, 
but recognizes the inherent hiatus in kind between the human and 
the brute, the gap that implies without explaining organized 
articulate language and "the use of utensils of varied application." 
" It is the very characteristic of modern research to discover hidden 
connections between the most divergent realities. It is the su- 
preme ideal of science to unify," says McCabe, and his essay is 
therefore essentially one more elucidation of the narrower monism. 
"The Mind of Primitive Man," on the other hand, shows little 
such tendency either way. 

" The Evolution of Mind^^ is a storehouse of interesting data 
and considerations garnered in part from literature ranging far 
afield in cosmology, terrestrial and celestial, chiefly (the author 
says) from "physics, organic chemistry, geology, paleontology, 
zoology, physiology, psychology, and anthropology. In par- 
ticular I wholly disclaim the ambition to put mechanical interpre- 
tations on the various phases of mental evolution." None the 
less, this would certainly be its influence on the mind of the average 
reader. 

We could indicate the material of the book perhaps in no better 
way than by quotation of the chapter-titles : " The two evolutionary 
series. The lowest forms of mind, The earliest forms of life. The 
appearance of brain. The development of the fish. The invasion 
of the land. Instinct and intelligence in the insect. Mind in the 
bird. The growth of the mammal brain. The dawn of humanity, 
and The advance of mind in civilization." An excellently fair 
sample of the material of these eleven chapters may be taken from 
that on Mind in the bird, p. 193: "Presentation, emotion, voli- 
tion, and memory are at some point in the story of evolution 

220 



Reviews 221 

irradiated by consciousness. ... As this cortex is proportionately 
developed in the higher birds and mammals, we may legitimately 
argue from analogy that they have a measure of consciousness. 
. . . All we know is that particular regions of the cortex are 
concerned in particular conscious functions;" p. 195: "We 
cannot say whether the analogy between the brain of the fish or 
the ant and the human brain is close enough to justify an in- 
ference." Here, then, we have a consciousness-criterion from 
analogy strictly a la McCabe, plus an outwearing localization of 
cerebral functions a la Ferrier and Flechsig. We have the same 
analogy affirmative in the birds, but wholly negative for the poor 
wise ant and the poorer fish! We confess we have no patience 
with this eclectic sort of argumentation, especially when based 
on our utter ultimate ignorance of the mode of working of the 
brain — *'at present ... a dark cavern in which the lamps of the 
anatomist'and physiologist do little more than increase our sense 
of mystery," as McCabe himself says (p. 16). How this dark 
cavern gets the light that shows Professor McCabe the conscious- 
ness in the bird, but that the ant and fish have none of it, we con- 
fess ourselves unable to observe. Perhaps certain "cortical 
regions" have not yet evolved, on this side of the Atlantic, to per- 
ceive these antiquated ultra-violet rays. • 

And the author's look ahead is as depressing as his survey 
behind: "We do not see the future evolution of mind even darkly, 
as in a glass. But we do foresee its ultimate fate. The time will 
come when humanity — a race of geniuses, judged by our modern 
standard — will wage the most titanic struggle that will ever be 
recorded in its calendar. Our sun must die as other suns have 
done and are doing; and no human art can create a substitute 
for its streams of energy. Slowly the red rays will grow feebler, 
and the arctic temperature creep toward the equator. All the 
magical engineering of that future race will be applied to prolonging 
the last hour of humanity's life. At last the central belt of the 
earth will sink to the cold of space, and the marvelous structure 
of brain will succumb to the natural forces which engendered it, 
and sink back into the elements from which it so slowly and so 
subtly compacted" (p. 281). This certainly is eloquent poetry 
well worthy the learned ecclesiastic who wrote it, but as philosophy 
it does not convince, for it utterly begs the question, the essential 
question of all questions mundane, as to the meaning of this 
phantasmagoria, whose quintessence is Individual Purposes. 
James's "Is Life Worth Living.?" and "The Will to Believe" 
answer it better. 



222 The Journal of Abnormal Psychology 

Professor Boas's book, " The Mind of Primitive Man^'^ is less 
full of romantic fact, and to a physiologist less interesting, but its 
logic is sounder, less partial, and more conclusive, and no book 
before it has done so ably what it has done. The abolition of 
racial prejudice seems to be one of the great ultimate aims of the 
writer's life work — witness his recent essay, "An Anthropolo- 
gist's View of War." Behind and supporting this high intention 
of the man is the unsurpassed learning and insight of the scientist, 
as this volume of co-ordinated Lowell Institute lectures plainly 
enough shows. 

The chapter-headings are as follows: "Racial prejudices, 
Influence of environment upon human types, Influence of heredity 
upon human types. The mental traits of primitive man and of 
civilized man, Race and language. The universality of cultural 
traits. The evolutionary viewpoint. Some traits of primitive 
culture. Summary, and Race problems in the United States." 
The chapter on the mental traits of primitive man would probably 
most interest the readers of the Journal. Boas follows the 
orthodox psychology in drawing sharp demarcation between brute 
and man in that no specimen of the former has the "abstract con- 
cepts accompanying action," while every human group, however 
primitive, possesses this faculty. He points out also that personal 
freedom in the use of utensils, etc., may be used as a criterion of 
humanity, despite the remaining mystery of the instincts by which 
animal masses perform very efiiciently complex constructive and 
useful actions. Comparing, on the other hand, the races of men^ 
he finds far more unity and similarity than we are in the habit 
of presuming. The gist of this chapter should be expressed in 
his own summary of it: "Our brief consideration of some of the 
mental activities of man in civilized and in primitive society has 
led us to the conclusion that these functions of the human mind 
are common to the whole humanity. It may be well to state 
here, that, according to our present method of considering biological 
and psychological phenomena, we must assume that these have 
developed from lower conditions existing at a previous time, and 
that at one time there certainly must have been races and tribes 
in which the properties here described were not at all, or only 
slightly, developed; but it is also true that among the present races 
of man, no matter how primitive they may be in comparison with 
ourselves, these faculties are highly developed [namely, the power 
to inhibit impulses, power of attention, originality of thought, and 
power of clear reasoning]. It is not impossible that the degree of 
development of these functions may differ somewhat among 
different types of men, but I do not believe that we are able at the 



Reviews 223 

present time to form a just valuation of the hereditary mental 
powers of the different races. A comparison of their languages, 
customs, and activities suggests that their faculties may be un- 
equally developed; but the dliferences are not sufficient to justify 
us to ascribe materially lower stages to some peoples, and higher 
stages to others. The conclusions reached from these considera- 
tions are therefore, on the whole, negative. We are not Inclined 
to consider the mental organization of different races of man as 
differing In fundamental points. Although, therefore, the dis- 
tribution of faculty among the races of man Is far from being known, 
we can say this much: the average faculty of the white race Is 
found to the same degree In a large proportion of individuals of 
all other races, and, although It Is probable that some of these races 
may not produce as large a proportion of great men as our own 
race, there Is no reason to suppose that they are unable to reach 
the level of civilization represented by the bulk of our own people." 

He points out In an interesting way how the social associations 
of sense Inpresslons and of activities are gradually replaced In the 
civilization process by Intellectual associations, accompanied by 
a loss of conservatism In certain directions. "The change from 
primitive to civilized society Includes a lessening of the number 
of the emotional associations, and an improvement of the tradi- 
tional material that enters into our habitual mental operations," — 
tendencies that one sees In the autogenetic evolution also, but 
which are not possible in mental defections owing to organic 
deficiencies in the brain. 

The last chapter of Professor Boas's book Is a far-reaching 
discussion of the Negro race-problem in the United States; In his 
opinion the melanochrolc racial characteristics will gradually be 
eliminated by absorption into the xanthochroic majority, — cen- 
turies hence. 

Fifteen pages of bibliographic notes end the volume, — a 
book that can hardly fail to Interest very many people who seek a 
broad outlook Into the early stages of human mind. The absence 
of an Index is by no means wholly compensated by the analytic 
table of contents, — an omission for which there seems never any 
excuse in any scientific work. 

Tufts Medical School George V. N. Dearborn. 



224 The Journal of Ahnormal Psychology 

l'etude experimentale de l'association des idees 
DANS LES MALADIES MENTALES. Aug. Ley et Paul Menzerath. 

Rapport de Psychologic, vi^ Congres Beige de Neurologic et 
de Psychiatric. 

Gand. 1911. Imprimerie A. Vandcr Haeghem. Pp.199. 

This report to the sixth Belgian Congress of Neurology and 
Psychiatry is based on an experimental study of association of 
ideas by means of the usual word tests. While a larger number 
of cases were examined the report is based on thirty-five cases, as 
follows: eleven of dementia praecox; six of maniac depressive in- 
sanity; six of toxicomania (morphinism, alcoholism); two of 
neurasthenia and psychasthenia; three of hysteria; two of trau- 
matic neurosis; two of paranoia; two of general paralysis, and one 
case of tripanosomiasis. 

These patients were given a selected list of test words, one at 
a time, by means of Roemer's instrument (Schalltrichter). For 
the measurement of the reaction time Hipp's chronoscope was 
used. Each patient was instructed to answer quickly without 
reflection and to give the first word that comes to his mind. By 
way of familiarizing him with the scope and method of analysis 
each patient was given a few test words and instructed in the 
manner of reacting properly before the regular test series were tried. 

The general conclusions which the authors draw are not as 
relevant as the particular findings in each case. We therefore 
give the latter in brief. 

I. Dementia Pr-^cox. Case 1. Adapts himself readily 
to the requirements of the experiment. The reactions are very 
superficial. The associations are almost always external; there is 
a predominance of mere asonance; despite the superficiality of 
the reactions, their time is prolonged over the normal. 

Stereotypy and perseveration are very marked throughout 
the series; this, of course, is pathognomic of the condition. It is 
noteworthy, too, that on account of the subject's apathy and 
indifference these characteristic features of dementia praecox were 
not revealed in the ordinary course of clinical examination and 
came to surface only at the time of these tests. 

The tendency to the formation of neologisms is also very 
marked. These are based generally on auditory analogies, such 
as cousin-cousine, rouge-rougine, chagrin-chagrine, cerveau- 
cerve (analogy with serve, explained by the subject to mean the 
female of cerf), aigle-aiglette. Here the patient revealed spon- 
taneously the mechanism of these neologisms by declaring: 
"/'<3z pense a regie et reglette^ 



Reviews 22 S 

There is no personal reaction to any of the test words. 
Affectivity is reduced to a minimum. The reaction words hardly 
deserve to be called associations, except in the very widest sense. 
They represent rather a sort of negativism; a defense oh the 
patient's part against the exploration of his mental sphere. 

Case 2. Here too the patient adapts himself readily to the 
experiment. The reactions are characterized by: a tendency to 
pure asonance, to perseveration, and to the formation of neolo- 
gisms. The latter sometimes surprise the patient himself who 
occasionally inquires, "What does this word mean.?" At other 
times the subject proceeds to explain the new word in his own 
fashion. There is absence of emotivity except when the emotive 
complex pertaining to the subject's own delirious notions of 
jealousy is touched. 

The reaction features of this case correspond in all essentials 
to the first, except that the time is not prolonged, like in the latter. 
On the other hand there are present in this case a number of re- 
actions showing incoherence. 

Case 3. The reactions in this case may be summarized as 
follows: Considerable lengthening of the reaction time; tendency 
to define the test word in the reaction and to antonyms (nega- 
tivism of Bleuler) ; perseveration in the type of reaction and marked 
absence of affectivity. Moreover patient himself is aware of the 
latter characteristic. 

Case 4. Presents the following essential features: Frequent 
repetition of the test word; tendency to antonyms and to stereo- 
typies, especially the doubling of numbers; perseveration in the 
reaction type; absence of emotivity; some incoherent reactions. 
The reaction time, while prolonged, became briefer as the ex- 
periment proceeded, probably as the efi^ect of habituation. 

Case 5. This case was marked by prolonged and very irregu- 
lar reaction periods and also by the following characteristics: 
Numerous neologisms; tendency to asonance; tendency to trans- 
late the test word (Flemish-French) or to repeat the test word in 
the original. The subject also manifested an erotic symbolism. 
Some answers he prepared beforehand. There was, at times, 
complete incoherence and absence of affectivity throughout, even 
in those instances in which the test words manifestly touched 
some affective complex. 

Case 6. Again we find superficial reactions consisting for 
the most part of attempts to supplement the meaning of the test 
word and complete absence of affectivity. The reaction time is 
very prolonged and very irregular. 

It is noteworthy that clinically this case resembled a mixed 



226 The Journal of Abnormal Psychology 

state of maniac depressive insanity more closely than any other 
condition (Kraepelin's Mischzustand). She presented, in fact, 
alternate periods of depression and of excitation and melancholiac 
delirium followed by affective manifestations towards her husband. 
The typical features of dementia prsecox, including absence of 
aifectivity, became evident only upon the application of these 
association tests. These characteristics were strong enough to 
leave no doubt concerning the correct diagnosis. It would thus 
seem that this method may prove particularly valuable in the 
differential diagnosis between initial dementia praecox and certain 
forms of maniac depressive insanity with which the former bears 
too close a clinical resemblance. 

Case 7. This case shows tendency to perseveration and trans- 
lation of the test words, play of words and neologisms. There is 
complete absence of emotivity. The reaction time was not 
registered properly by the chronoscope. Where present the 
record showed marked prolongation. 

Case 8. Reactions for the most part superficial; their time 
very prolonged, in a few instances, over minutes. Exterior signs 
betray the preservation of some affectivity. There is even 
reddening of the face upon the appearance of a test word touching 
upon the patient's complex, — a most unusual manifestation in 
dementia prsecox. 

The other three cases contribute only some notes. The 
patients' attitude, particularly their mannerisms and their ex- 
treme negativism, more than the extent of the dementia, precluded 
a thorough analysis in these cases. 

II. Maniac Depressive Insanity. Case 1. This sub- 
ject's reactions are for the most part superficial. The reaction 
time is very irregular, short and long intervals alternating. There 
is motor superexcitability and greatly decreased voluntary in- 
hibition; labile emotivity and numerous egocentric reactions. 

Case 2. Here the reactions present nothing abnormal 
qualitatively. Time of reaction is often very prolonged. Logor- 
rhea and partial loss of voluntary inhibition are also present. 
The influence of the morbid complexes ("crime" and "unhappy 
conjugal life") are very easily discerned. In this case it was ob- 
served in connection with the reproduction of the test words 
(Jung's method) that the words touching upon the patient's 
complex were sometimes immediately forgotten. 

Case 3. Practically the same psychic traits as the former two : 
very superficial and prolonged associations, motor-verbal excitation 
("Rededrang"); very great emotivity and pronounced egocentri- 
city. The complexes, clearly discernible, are " sex " and " disease." 



Reviews 



111 



Case 4. Superficial associations: motor superexcitation as 
manifested in tendency to react with phrases and in series; great 
emotivity as well as egocentricity; erotolalia and erotic complex; 
original definitions. 

Case 5. Like the above; reaction in phrases, by definition 
and in series. Very labile and superficial emotivity, the patient 
passing readily from tears to laughter. 

The above cases were examined during the maniacal stage; 
the following two, during the period of depression. 

Case 6. Nothing qualitatively abnormal in the reactions; 
they show, however, the characteristic irregularity in time, 
egocentricity, and pronounced emotivity. Here, too, the com- 
plexes manifested are "sex" and "disease." 

Case 7. Prolonged reactions occurring frequently in phrases 
instead of single words. In addition to the usual egocentricity 
and eniotivity, which are very marked, subject denotes inhibition 
whenever she cannot react to the test word with some reference to 
her complexes which are "disease" and "remorse" (suicidal 
attempt). 

III. Toxicomania. Case 1. Chronic alcoholic intoxica- 
tion. Shows: reduced emotivity, even during inhibition towards 
complex; coprolalia; psychomotor excitability; frequent errors 
of apperception. 

Case 2. Polytoximania (alcohol, opium, also veronal, trional, 
pyramidon, antipyrin, etc.). Tests taken during convalescence. 
Qualitatively reactions are normal, although below the subject's 
level of culture. Their time is very irregular. Egocentricity and 
complex constellation as follows: family, disease, remorse, and 
self-accusation. Easily awakened but very labile emotivity. 

Case 3. Chronic alcoholism. Prolonged reaction time. 
Emotivity and motor inhibition decreased. Numerous com- 
plexes (disease, sex, sterility), aboulia, but no lasting emotivity. 

Case 4. Alcoholism of several years' duration. Findings 
resemble those in case 3 very closely. 

Case 5. Chronic alcoholism. Reaction time very brief, at 
times more so than in the normal. Psychomotor excitation, but 
only slight emotivity; also some errors of apperception. Com- 
plexes: disease, remorse over the past, and self-accusation. 

Case 6. Chronic alcoholism. In this case affectivity is 
marked, and nearly all reactions refer to some complex (Jung's 
Complexkonstellation) . 

IV. Neurasthenia AND PsYCHASTHENiA. Case 1. Subject 
seems too preoccupied to give satisfactory reactions, and is seldom 
satisfied with his replies; feels that he could have made a better 



228 The Journal of Abnormal Psychology 

record. The very irregular reaction times and frequent inhibi- 
tions are probably brought about by this state of the patient's 
mind more than by the affective quality of the test words. 

Case 2. Here, too, we find exaggerated attention, anxiety to 
do well, and dissatisfaction, resulting in prolonged reactions and 
frequent inhibitions. 

V. Hysteria. Case 1. With few exceptions, all test words 
are related to a sex complex. The patient herself recognizes this 
even before the intense inhibition provoked by certain words is 
manifest. 

Cases 2 and 3. Qualitatively most reactions appear normal. 
Affective reactions are very marked. There are also present de- 
fense reactions, sometimes unconscious, against the exploration 
of the complexes. 

VI. Traumatic Neurosis. Two cases of this disorder were 
examined. The findings resembled those reported by Pototzky,' 
who has also used this method in the investigation of the affective 
complexes in traumatic neurosis. As in Pototzky's two cases, one 
patient manifested intense emotivity in connection with everything 
that concerned the accident formally responsible for the trouble, 
while the other was indifferent. 

Vn. Paranoia. Case 1. Reactions qualitatively normal; 
emotional inhibition for the test words pertaining to the complex. 
In fact it was difficult to turn introspection into channels which 
would throw any light upon the subject's delirious thoughts. 

Case 2. Was even more difficult to approach. 
, VIII. General Paralysis. Two cases showing alike: 
tendency to react in phrases; marked egocentricity without emo- 
tive inhibition; euphoric satisfaction and eroticism; some stereo- 
typies. The time of reaction somewhat prolonged. 

In other cases of general paralysis it was found that during the 
premonition period the associations are frequently normal; they 
also become thus in more advanced cases during the period of re- 
mission, so that this method of analysis may prove a valuable test 
for the subject's condition at a particular time. 

IX. Tripanomosiasis. The case of sleeping sickness, a 
report of which was published in the Annales de la Societe de Neu- 
rologie (1911), presents nothing unusual under this test except a 
very persistent lengthening of the reaction time. 

J. S. Van Teslaar. 

^ Die Verwertbarkeit des Assoziationsversuches fur die Beurtheilung der 
traumatischen Neurosen. Monatschr. f. Psych, u. Neurol., 1909, No. 6. 



Reviezus 229 

UBER EXPERIMENTELLE BEINFLUSSUNG DES VORSTELLUNGS- 

VERLAUFS BEi GEiSTESKRANKEN, nebst eiuer Kritik der As- 
soziationsexperimente an Geistesgesu7iden, von Dr. Max Levy-Suhl. 
Leipzig, Verlag V. Johann Ambrosius Barth, 1911. Pp. vi, 142. 

It is well known that in various mental diseases patients take 
up words they overhear and spontaneously associate them with 
various trains of thoughts in a manner foreign to normal life. 

The present work is devoted to a systematic study of this well- 
known peculiarity, not only in manias, in connection with which it 
has been studied heretofore, but in other forms of insanity as well. 

The problem which Dr. Levy-Suhl set for himself is as follows: 
How do patients of different clinical categories react towards 
certain definite words purposely thrown in their way (Ziehen's 
Assoziative Reaction auf Zwischenruj)t Furthermore, does the 
behavior and reaction of patients towards such verbal stimuli 
present any pathognomic features on the basis of which it might 
be possible to classify the cases into definite psychological groups.^ 
In other words, is a patient's reaction to this kind of stimulus in 
any way characteristic of his pathological state .^ 

The investigations were undertaken in the patient's usual 
surroundings, without instruments or other distracting arrange- 
ments. For the purpose of the experiment the patient's mutter- 
ings were taken down stenographically, and in their midst the 
reaction word given in a clear tone without previous warning or 
instruction of any kind. The precaution was taken that there 
should be no similarity in sound or meaning between the patient's 
last words and the reaction stimulus. His behavior and the 
course of his incoherent speech immediately following were care- 
fully noted in shorthand. In some cases it was necessary to 
start off the patient on the road of speaking to himself by en- 
gaging him in some conversation of an indifferent sort. Occa- 
sionally reaction words were called out within the hearing of 
patients not engaged in talking to themselves, and the results 
noted. Here, too, there was no preliminary understanding with 
the patient or preparation of any kind. 

Forty different cases belonging to different clinical categories 
were thus experimented upon. Without regard to their psy- 
chiatric or clinical diagnostic position these cases were classified 
on the basis of their reaction to the experiments in question. It 
was found that the cases grouped themselves into four different 
classes presenting the following characteristic features respectively: 

First Group. Comprising those whose reactive behavior ap- 
proaches the normal. 



230 The Journal of Abnormal Psychology 

Second Group. Cases characterized by indifferent hyper- 
prosexia. This group comprises the cases whose behavior has 
necessitated the formulation of such terms in clinical psychiatry 
as ideational, maniacal, and primary flight of ideas. Levy-Suhl 
prefers Ziehen's term, hyperprosexia, because it is psychologically 
more clearly delineated, and also because this term is noncom- 
mittal with reference to the diagnostic import of the phenomenon 
to which it refers. In other words the term is purely descriptive 
and used as such. Under hyperprosexia Ziehen understands a 
psychopathic condition in which "hypervigility " is combined 
with "hypotenacity" of attention. As a result of this condition 
reaction words are promptly seized upon by the subject and the 
antecedent flow of ideas as quickly abandoned. 

Characteristic features of this class of hyperprosexia are: 

1. Complete indifference towards the act of interruption as 
shown by quick, superficial reactions. In other words the subject 
is ready to abandon his own thoughts and turns his attention 
promptly to any verbal stimulus, no matter what the new order 
of ideas may be. He may react associatively either to the tone 
or to the new images invoked. The reactions are superficial but 
prompt, and as a rule show no relation to the subject's former 
preoccupation. 

2. In addition to the formal indifference there is a very 
marked neutrality towards the content. The associative relations 
between stimulus and reaction word follow a path unaffected by 
the feeling tone or the affective character of the former. Thus, 
even to a word like "seisachtheia," meaningless to the lay ear, 
the patient reacts the same as to "death" or "shame." 

3. The associations proper show no deep relation and no 
elaboration; they are largely neutral, impersonal, hence verbal 
forms, plays on words, are predominant. 

Third Group. Selective hyperprosexia. Here, in contrast 
to the second group, the hyperprosexia is selective and presents 
more or less the marks of an affective elaboration. 

1. The heightened ausprechharkeit, or readiness to react 
with a flow of words, is concerned with a definite pathological 
"Totalkonstellation," and the reactions belong to some special 
groups of images. Those test words which fail to touch in some 
way the peculiar groups of images to which alone the patient is 
sensitive at the time are resented as impertinent intrusions or 
remain entirely unnoticed by him. 

2. It follows that, again in contrast with the second group, 
the meaning of the reaction word is of importance in the shaping 
of the reaction to which it gives rise. 



Reviews 231 

3. Finally, the associations proper present a more critical 
and personal character. Their content may be the result of 
intimate elaboration and peculiarly personal. Superficial verbal 
associations occur rarely, if at all, while in the second group 
associations of this class are the rule. 

Fourth Group. Hypervigil reaction with contamination and 
dissociation. Here the subject does not turn away from his flow 
of thoughts, but the test word or some term associatively awakened 
by it is taken up and uncritically incorporated in the verbal image 
series with which the subject happens to be concerned at the 
moment of the experiment, irrespective of the resulting nonsense. 
In other words, hypervigility of attention is still present, but no 
hypotenacity; consequently we deal no longer with hyperprosexia 
in the strict sense of the term. On the contrary, the condition 
which confronts us here may be described as a hypertenacity of 
attention (contaminating or nonsensical hypervigil reaction). 

Furthermore, the notion of hyperprosexia is untenable in 
this group of reactions because the incoherence of the image series 
becomes so great that a principle or category of associative relations 
in the series of succeeding words is hardly to be recongized any 
longer; the associative bond from reaction word to the immedi- 
ately succeeding flow of words is too faint to be recognized. 

Associative elaboration, when present or at all discernible, 
is at any rate more meager than in second group. As in the 
latter group the associations proper have a superficial character 
for the most part, although occasionally reactions of individual 
order not unlike those typical of group three may be found here. 

A comparison of the clinical and diagnostic features of the 
forty-four cases studied with the psychopathic characteristics 
of the four groups into which they have been arranged by means 
of this psychological test reveals the following facts: 

In the first group, besides a case of exhaustion delirium with 
secondary hyperthymia, on the way to recovery, belong three cases 
of dementia paralytica. 

In the second group eleven cases, — ten clinically correlated 
cases of mania, cyclothymia, periodic mania, and hypomania, and 
one "case of acute paranoia, passing into mania." 

Closely related to this group (varying in certain psycho- 
logical respects) stand three cases of hysterical psychosis, one 
case of post infectious exhaustion, and one case of acute hallucina- 
tory paranoia with post operative delirium. 

In the third group there are sixteen cases. These, with one 
exception, illustrate, clinically, various forms of paranoia. The 
exception is a case of maniacal exaltation which, strictly speaking, 



232 The Journal of Abfiormal Psychology 

belongs psychologically somewhere between the second and third 
group. 

The fourth group comprises eight cases: four dementia 
prsecox, three special forms of paranoia, and one dementia paralytica 
with ideational flights. 

It will be thus seen that the psychological divisions correspond 
closely to certain clinical differentiations. This is undoubtedly 
the most important result of the present study. 

It is not surprising, of course, to find that dementia paralytica 
does not fall into a single psychological category. In view of its 
manifold psychopathic clinical forms this would hardly be expected. 

On the other hand it is noteworthy how clearly this psycho- 
logical test differentiates the maniacal stage of paralysis from the 
mania of functional psychosis in spite of the formal similarity 
between the two. It appears that this psychological test, applied 
to all forms of autocheonous ideational flights, may help towards 
an early differential diagnosis. Further research upon this test 
should prove not only of scientific value but of great practical 
interest as well. 

J. S. VAN TeSLAAR. 



BOOKS RECEIVED 

THE OUTLINES OF EDUCATIONAL PSYCHOLOGY. By William 

Henry Pyle, Ph.D. (University of Missouri). Warwick & York, 
Inc., "Baltimore. 1911. $1.25 net. Pp. x, 247. 

THE SEXUAL LIFE OF THE CHILD. By Dr. Albert Moll. 
Translated from the German by Dr. Eden Paul, with an intro- 
duction by Edward L. Thorndike. The Macmillan Company, 
New York, 1912. $1.75. Pp. xii, 339. 



^0,0, 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



OCTOBER-NOVEMBER, 1912 



THE MEANING OF IDEAS AS DETERMINED BY 
UNCONSCIOUS SETTINGS^ 

BY MORTON PRINCE, M.D. 

1 THINK the theory which I shall maintain in this paper 
will become clearer if, before taking up the main 
theme, — the unconscious settings of ideas, — I devote 
a few pages to a preliminary statement of the psy- 
chology of perception and "meaning." 

A perception, or, what is in principle the same thing, 
an idea of an object, although apparently a simple thing, 
is really, as a rule, a complex affair. Without attempting 
to enter fully into the psychology of perception (and ideas), 
and, particularly into the conventional conception of percep- 
tion as usually expounded in the text-books, — a conception 
which to my mind is inadequate and incomplete,^ — it is 
sufficient for our immediate purposes to point out in a 
general rough way the following facts concerning perception. 
Perception may be regarded both as a process and as a 
group of conscious elements, some of which are within the 
focus of attention or awareness, and some of which are out- 
side this focus. As a process it undoubtedly may include 
much that is entirely unconscious and, therefore, without 
conscious equivalents, and much that appears in conscious- 
ness. As a group of conscious elements it is a fusion, 
amalgamation, or compounding of many elements. 

1 Read at the meeting of the American Psychopathological Association at 
Boston, May 29, 1912. 

■^In that it takes into account only a limited number of the data at- our dis- 
posal and neglects methods of investigation which afford data essential for the 
understanding of this psychological process. 

233 



234 Ideas as Determined hy Unconscious Settings 

My perception of X, for example, whom I recognize as 
an acquaintance, is much more than a cluster of visual 
sensations, — I mean the sensations of color and form that 
come from my retina when I see him, and which combined 
are an image of his person. Besides the latter it includes 
a number of imaginal memory images, some of which are 
only in the fringe of consciousness, and can only be recog- 
nized by introspection, or under special conditions. These 
images may be (as they most often are) visual, orienting him 
in space and in past time, or in various associative rela- 
tions, according to my previous experiences; they may be 
auditory — the imaginal sound of his voice, or verbal images 
of his name; or they may be the so-called kinesthetic images, 
etc., and all these images supplement the actual visual 
sensations of color and form I have mentioned. That 
such images take part in perception is, of course, well recog- 
nized in every text-book on psychology where they will be 
found described. It is easy to become aware of them under 
certain conditions. For instance, to take an auditory 
perception from everyday life, you are listening through 
the telephone and hear a strange voice speaking. Aside 
from the meaning of the words, you are conscious of little 
more than auditory sensations, although you do perceive 
them as those of a human voice and not of a phonograph. 
Then, of a sudden, you recognize the voice as that of an ac- 
quaintance. Instantly visual images of his face, and per- 
haps of the room in which he is speaking, and his situation 
therein, of the furnishings of the room, etc., become asso- 
ciated with the voice. Your perception of the voice now takes 
on a fuller meaning in accordance with these imaginal images. 
In such an experience, common probably to everybody, the 
secondary images which take part in perception are unusually 
clear and easily detected. 

The incorporation of secondary images as elements 
essential for perception may be shown experimentally, as in 
the following observation which I believe to be unique. 
By way of explanation let me point out that if memory 
images are habitually synthesized with sensations to form a 
given perception, and if perception is a matter of synthesis, 
theoretically, it ought to be possible to dissociate these 



Morton Prince, M.D. 23 S 

images. Further, in that case, the perception as such ought 
to disappear. That this theoretical assumption correctly 
represents the facts I have been able to demonstrate by the 
following experiment which I have repeated many times. I 
should first explain that, as Janet was the first to demonstrate 
by certain technical procedures, some hysterics can be dis- 
tracted in such a way that the experimenter's voice is not 
consciously heard by them, but is heard and understood 
subconsciously. The ordinary procedure is to whisper to 
the subject while his attention is focused on something else. 
The whisper undoubtedly acts as a suggestion that the sub- 
ject will not consciously hear what is whispered. The 
whispered word-images are accordingly dissociated but are 
perceived coconsciously, and whatever coconsciousness ex- 
ists can be in this way surreptitiously communicated with 
and responses obtained without the knowledge of the per- 
sonal consciousness. In this way I have been able to make 
numerous observations showing the presence of dissociated 
coconscious complexes which otherwise would not have 
been suspected. Now, the experiment which I am about 
to cite was made for the purpose of determining whether cer- 
tain experiences for which the subject had amnesia were co- 
consciously remembered, but the results obtained, beside 
giving affirmative evidence on this point, furnished certain 
instructive facts indicative of the dissociation of secondary 
images. 

The subject. Miss B., was in the state known as B 
IV a, an hypnotic state, her eyes closed. While she was con- 
versing with me on a subject which held her attention I 
whispered in her ear with the view of comiyiunicating with co- 
conscious ideas as above explained. While I was whis- 
pering she remarked, "Where are you.^" "Where have 
you gone.^" and later asked why I went away and what I 
kept coming and going for. 

On examination it then appeared that it seemed to her 
that during the moments when I whispered in her ear I had 
gone away. That is to say, she could no longer visualize 
my body, the secondary visual images being dissociated with 
my whispered words. At these times, however, she con- 
tinued the conversation and was not at all in a dreamy state. 



236 Ideas as Determined by Unconscious Settings 

Testing her tactile sense it was found that there was no 
dissociation of this sense during these moments. She felt 
tactile impressions while she was not hearing my voice, but 
she explained afterwards (while whispering, of course, I 
could not ask aloud questions regarding sensations) that 
when I touched her and when she held my hand, palpating 
it in a curious way as if trying to make out what it was, she 
felt the tactile impressions, or tactile sensations, but not 
naturally. It appeared as the result of further observations 
that this feeling of unnaturalness and strangeness was due 
to a dissociation of the secondary visual images which nor- 
mally occur with the tactile images. (She described the 
tactile impressions of my hand as similar to those she felt 
when she lifted her own hand when it had "gone to sleep." 
It felt dead and heavy as if it belonged to no one in particu- 
lar. My hand felt as though it might be anybody's hand.) 

Testing further it was found that when before abstrac- 
tion she held my hand she could definitely visualize the 
hand, arm, and even face. While she was thus visualizing 
I again abstracted her auditory perceptions by the whis- 
pering process. At once the secondary visual images of 
my hand, etc., disappeared. As with the auditory per- 
ceptions she could not obtain these visual images, although 
a moment before she could visualize as far as the elbow. 

Desiring now to learn whether these dissociated visual 
images were perceived coconsciously, I whispered, at the 
same time holding her hand, "Do you see my hand, arm, 
andface.?" She nodded (automatically), "Yes." "DoesjA^ 
[meaning the personal consciousness] see them .^" (Answer 
by nod), "No." (The personal consciousness (B IV a) was 
unaware of the questions and the nodding, the latter was 
performed subconsciously.) 

This experiment was repeated several times. As often 
as she ceased to hear my voice she ceased to visualize my 
hand, though she could feel it without recognizing it. It 
follows therefore that the dissociation of the auditory per- 
ceptions having robbed the personal consciousness of all 
visual images of my body, the previous tactual perception 
of my hand lost thereby its visual images and ceased to be 
a perception. 



Morton Prince, M.D. 237 

We have seen that a tactual perception of the body 
includes imaginal visual and sensory images besides the 
tactile sensation. Now, of course, if sensation is so dissociated 
that one has complete anesthesia, no tactile sensation 
can be perceived. Under such conditions an anesthetic 
person theoretically would not be able to imagine the dis- 
sociated tactual sensations and the associated imaginal 
visual images included in tactile perception. Such a person 
would not be able to visualize his body. In other words, in 
accordance with the well-known principle that the dis- 
sociation of a specific memory robs the personal conscious- 
ness of other elements of experiences synthesized with the 
specific memory, the dissociation of the sensory images 
carries with it the visual images associated in perception. 
This theoretical proposition is confirmed by actual observa- 
tion. Thus B. C. A. in one hypnotic state has general anes- 
thesia so complete that she has no consciousness of her body 
whatsoever. She does not know whether she is standing or 
sitting, nor the attitude of her limbs, or her location in 
space; she is simply thought in space. Now it is found that 
she cannot visualize any part of her body. In contrast 
with this she can visualize the experimenter, the room, 
and the objects in the room, but not her body. The dis- 
sociation of the tactual field from consciousness is so complete 
that she cannot evoke imaginal tactual images of the body, 
and the dissociation of these images carries with it that of 
the imaginal visual images synthesized with them through 
experience. Visual images of the environment, however, 
not being synthesized with the tactual body-images can be 
still evoked. 

So we see from observations based on introspection and 
experimentation that perception includes, besides primary 
simple sensations of an object, secondary imaginal images 
of various kinds and in various numbers. 

i The Psychological Settings and Meaning of Ideas. — What I 
have said thus far refers to the content of an idea or per- 
ception so far as it is a compound of images or perception 
proper. But this is not the whole of what is included in an 
idea. Ideas have "meaning" as well; so that we may de- 



238 Ideas as Determined hy Unconscious Settings 

scribe the content of ideas as perception plus meaning.^ 
Meaning is derived from and determined by past experi- 
ences. That is to say, ideas have associative relations to 
objects, thoughts, actions, conduct, stimuli, constellated 
ideas, etc., i. e.^ past experiences represented by conserved 
complexes. As a result of such previous experiences various 
associations are built up and these complexes form the setting 
or context which gives ideas meaning. This setting also 
determines the attitude of mind, point of view, interest, 
etc. Just as the context in a printed sentence through the 
ideas contained therein determines the meaning of a given 
word, so in the process of all perceptions the associated ideas 
give meaning to the perception. Indeed it is probable that 
the context as a process determines what images shall become 
incorporated with sensations to form the nucleus of the per- 
ception. Perception or idea thus takes one meaning ac- 
cording as it is constellated with one complex, and another 
meaning according as it is constellated with another com- 
plex. 

This may be illustrated by the following: We will 
suppose that three persons in imagination perceive a certain 
building used as a department store on a certain street I 
have in mind now, in a growing section of the city. One of 
these persons is an architect, another is an owner of property 
on .this street, and the third is a woman who is in the habit 
of making purchases in the depaiftment store. When the 
architect thinks of the building he perceives it in his mind's 
eye in an architectural setting, that is, its architectural style, 
proportions, features, and relations. His perception in- 
cludes a number of secondary images of the neighboring 
buildings, of their styles of architecture, and of their relations 
from an esthetic point of view. In the perception of the 
owner of property there are also a number of secondary 
images, but these are of the passing people and traffic, of 
neighboring buildings as shops and places of business. In 
the perception of the woman the secondary images are of the 
interior of the store, the articles for sale, clothes she would 
like to purchase, and possibly bargains dear to her heart. 

^For an able discussion of ideas and meaning see R. F. A. Hoernle, Image, 
Idea, and Meaning"; Mind, N. S., No. 61, 1907. 



Morton Prince, M.D. 239 

Plainly each perceives the building from different points of 
view. Each might perceive the building from the same 
point of view, but the point of view differs because of 
differences in the past experiences of each. 

In the case of the architect these experiences were those 
of previous observations on the architecture of the growing 
neighborhood. In the case of the property owner they were 
of thoughtful reflections on the future development of 
the neighboring property, on the industrial relations of the 
building to business, and on the speculative future value of 
the property. In the case of the woman they were of pur- 
chases she had made, of articles she had seen and desired, 
of scenes inside the shop, etc. Out of these experiences 
respectively a complex was built and conserved in the mind 
of each. The idea of the building is set in these respective 
experiences which, therefore, may be called its setting. 
The imaginal perception of the building obviously has a 
different meaning for each of our three observers, and it is 
plainly the setting which governs the meaning, i. e., an 
architectural, industrial, or shopping meaning, as the case 
happens to be; and we may further say the setting determines 
the point of view or attitude of mind or interest. Either 
the perception proper of the building or the meaning may he 
in the focus of attention, and the other then recedes into the 
background or the fringe of awareness. 

Further, different affects may enter into each setting 
and therefore into the perception. With the architectural 
perception there may be linked an esthetic joyful emotion; 
with the industrial perception a depressing emotion of anxi- 
ety; with the shopping perception perhaps one of anger. 
(This linking of an emotion of course has a great importance 
for psychopathic states.) 

Settings may be partly Unconscious. — Now the thesis 
which I wish to present is one which is not so readily ac- 
cepted by psychologists, namely, that the setting which 
determines the meaning of ideas may be present in the con- 
tent of consciousness, or it may be and probably generally 
is, partly conscious and partly unconscious. That is to say, 
in the latter case the setting is a part of a complex mechan- 
ism of which certain elements may emerge into the focus of 



240 Ideas as Determined by Unconscious Settings 

awareness or into the fringe of consciousness to be the 
meaning, while the remaining elements remain submerged, so 
to speak, hidden beyond all conscious recognition. Thus, 
although in this case the meaning is conscious it is a part of a 
complex which is largely unconscious. 

The data supporting this theory are numerous, although 
its actual demonstration is difficult. The theory would 
explain the behavior of ideas in obsessions, such as the 
phobias and even impulsions. The data are derived from 
the analysis of associative ideas, synthetic experiments, and 
pathological phenomena. 

The theory makes use, of course, of the theory of un- 
conscious processes just as a theory of gravitation or magne- 
tism might make use of the theory of ether. It is beyond 
the scope of this paper to adduce the evidence for uncon- 
scious processes in general. I will merely say that this evi- 
dence is drawn from a large and varied number of normal, 
pathological and experimental phenomena. 

It is obvious that all past experiences which originated 
the meaning to an idea cannot be in consciousness at a given 
moment. If I carefully introspect my imaginal perception 
or idea of an object, say of a politician, I do not find in my 
consciousness all the elements which have given me my 
viewpoint or attitude of mind towards him — the meaning 
of my idea of him as a great statesman or a demagogue, 
whichever it be — and yet it may not be difficult, by re- 
ferring to my memory, to find the past experiences which 
have furnished the setting which gives this viewpoint. 
Very little of all these past experiences can be in the content 
of consciousness and much less in the focus of attention 
at any given moment, nevertheless I cannot doubt that these 
experiences really determine the meaning of my idea, for if 
challenged I proceed to recite this conserved knowledge; 
and so it is with every one who defends the validity of the 
meaning of his ideas. 

The question at once comes to mind in the case of any 
given perception, how much of past experiences (associated 
ideas) is in consciousness as the setting which provides the 
meaning.? 

Although all past experiences which are responsible for 



Morton Prince, M.D. 241 

the meaning of any idea cannot be in the content of con- 
sciousness, yet the meaning must be in consciousness, else 
the term "meaning" would have no meaning — it would 
be sheer nonsense to talk of ideas having meaning. As I 
have said, the meaning may be in the focus of attention, or 
it may be in the fringe or background, according to the point 
of interest. If in the focus of attention, meaning plainly 
may include ideas of quite a large number of past experi- 
ences, but if in the background it is another matter. In either 
case it may be held, and probably in many instances quite 
rightly, that meaning is a short summary of past experi- 
ences, or summing-up in the form of a symbol, and that this 
summary or symbol is in the focus of attention or in the 
fringe of awareness, i. ^., is clearly or dimly conscious. Thus 
in one of the examples above given, the industrial meaning 
of the owner's idea of the building might be a short summing- 
up of his past cogitations on the business value of the 
property; in the case of my idea of the politician, the symbol 
statesman or demagogue, as the case might be, might be 
in consciousness and be the meaning. All the rest of the 
past associative experiences in either case would furnish 
the origin of the meaning and setting, but would not be the 
actual functioning meaning or setting itself. 

When speaking colloquially of the content of conscious- 
ness, we have in mind those ideas or components of ideas — 
elements of thought — which are in the focus of attention, 
and therefore that of which we are more or less vividly aware. 
If you were asked to state what was in your mind at a given 
moment, it is the vivid elements, upon which your attention 
was focused, that you would describe. But, as every one 
knows, these do not constitute the whole field of consciousness 
at any given moment. Besides these there is outside the 
focus a conscious margin or fringe of varying extent (con- 
sisting of sensations, perceptions, and even thoughts) of 
which you are only dimly aware. It is a sort of twilight- 
zone in which the contents are so slightly illuminated by 
awareness as to be scarcely recognizable. The contents 
of this zone are readily forgotten owing to their having been 
outside the focus of attention; but much can be recalled 
if an effort to do so (retrospection) is made immediately 



242 Ideas as Determined hy Unconscious Settings 

after any given moment's experience. Much can only be 
recalled by the use of special technical methods of investi- 
gation. I believe that the more thoroughly this wonderful 
region is explored the richer it will be found to be in conscious 
elements. 

It must not be thought that because we are only dimly 
aware of the contents of this twilight zone therefore the 
individual elements lack definiteness and positive reality. 
To do so is to confuse the awareness of something with that 
something itself. To so think would be like thinking 
because we do not distinctly recognize onjects in the dark- 
ness, that therefore they are but shadowy forms without 
substance. When in states of abstraction or hypnosis the 
ideas ot this fringe of attention are recalled, as often is easily 
done, they are remembered as very definite, real, conscious 
elements, and the memory of them is as vivid as that of 
most thoughts. That these marginal ideas are not "vivid" 
at the time of their occurrence means simply that they are 
not in such dynamic relations with the whole content of 
consciousness as to be the focus of awareness or attention. 
What sort of relations are requisite for "awareness" is an 
unsolved problem. It seems to be a matter not only of 
synthesis but of dynamic intensity within the synthesis. 

However that may be, outside that dynamic synthesis 
which we distinguish as the focus of attention we can at 
certain moments recognize or recall to memory (whether 
through technical devices or not) a number of different 
conscious states. These may be roughly classified as follows: 

1. Visual, auditory, and other sensory impressions 
to which we are not giving attention {e. g., the striking of a 
clock; the sound of horses passing in the street; voices from 
the next room; coenesthetic and other sensations of the 
body). 

2. The secondary sensory images of which I spoke at 
the beginning of this paper as taking part in perception. 

3. Associative memories and thoughts pertaining to 
the ideas in the focus of attention. 

4. Secondary independent trains of thought not re- 
lated to those in the focus of attention. (As when we are 
doing one thing or listening to conversation and thinking 



Morton Prince, M.D. 243 

of something else. Very likely, however, what appear to be 
secondary trains are often only alternating trains. I have, 
however, a considerable collection of data showing such 
concomitant secondary trains in certain subjects.) Such 
trains can be demonstrated as a precisely differentiated 
^'stream" of consciousness in absent-minded conditions, 
where they may constitute a veritable doubling of conscious- 
ness. 

Some of these marginal elements may be so distinctly 
within the field of awareness that we are conscious of them, 
but dimly so. Others, in particular cases at least, may be 
so far outside and hidden in the twilight obscurity that the 
subject is not even dimly aware of them. In more technical 
parlance we may say, they are so far. dissociated that they 
belong to an ultra-marginal zone and are really subcon- 
scious. Evidence of their having been present can only 
be obtained through memories recovered in hypnosis, ab- 
straction, and by other methods. These may be properly 
termed coconscious. Undoubtedly the degree of awareness 
for marginal elements, i. e., the degree of dissociation be- 
tween the elements of the content of consciousness, varies 
at different moments in the same individual according to the 
degree of concentration of attention and the character of 
the fixation, e. g., whether upon the environment or upon 
inner thoughts. It also varies much in different individuals. 
Therefore some persons lend themselves as more favorable 
subjects for the detection of marginal and ultra-marginal 
states than others. Furthermore, according to certain 
evidence at hand, there is in some persons at least a constant 
shifting or interchange of elements going on between the 
field of attention, the marginal, and the ultra-marginal 
zone, — what is within the first at one moment is in the 
second, or is entirely subconscious the next, and vice versa. 

Amnesia develops very rapidly for the contents of the 
twilight region as I have already stated, and this renders 
their recognition difficult.^ 

Let us now return from this general survey of the fringe 

^The development of amnesia seems to be directly proportionate to the degree 
of awareness, provided there are no other dissociating factors such as an emotional 
complex. 



244 Ideas as Determined by Unconscious Settings 

of consciousness to our theme — the setting which gives- 
meaning to ideas. 

It is obvious that theoretically, when I attend to the per- 
ceptive images of an idea, the meaning of the idea not being 
in the focus of awareness, may be found amongst the con- 
scious states that make up the fringe of the dynamic field. 
For instance, if my idea of a certain politician, my knowledge 
of whom, we will say, has been gained entirely from the 
newspapers, is that of a bad man, a "crook," this meaning 
or setting may be dimly in the fringe of my awareness. It 
may be, perhaps, only a summary of all the knowledge I have 
acquired regarding him. The origin of this meaning — a 
crook — I can easily find in my associative memories of 
what I have read. But there would seem to be no need for 
all these to persist as a functioning setting — a short sum- 
mary in the form of an idea, secondary image, a word or 
symbol of a bad man may be sufficient. The same principle 
is applicable to a large number of the simple perceptions 
of objects in my environment — a book, an electric lamp, 
a horse, etc. 

Passing over such normal ideas of everyday life as 
incidental to our main purpose, when we examine certain 
pathological ideas (phobias) we find that the principle of 
"fringe and meaning" is supported by the actual facts of tech- 
nical observation. We find in the fringe of consciousness, 
judging from my own observations, conscious elements 
which in particular cases may even give a hitherto unsus- 
pected meaning to the pathological idea. For this and other 
reasons I am in the habit when investigating a pathological 
case, like an obsession, of inquiring into the whole con- 
tent of consciousness and particularly the fringe of atten- 
tion, and reviving the ideas contained therein, particularly 
those for which there is amnesia. It must be borne in mind 
that a person may be only dimly aware or totally unaware 
of the thoughts, images, sensations, etc., which make up the 
fringe of consciousness at any given moment. Moreover 
amnesia for this fringe, even when there is more or less 
awareness for its contents, ensues very rapidly, and the mem- 
ory of the same cannot be recovered by the ordinary methods 
of retrospection. And yet these thoughts, images, etc., 



Morton Prince, M.D. 245 

■contribute to the whole content of consciousness of the 
moment. 

Let us take the case of a person who has a pathological 
fear and who, as we know is often the case, can give no ex- 
planation of his viewpoint. The fear may be of fainting 
or of thunder storms or of a particular disease, say cancer, 
or of so-called "unreality" attacks or what not. This so- 
called "fear" is, of course, a perception of self or other ob- 
ject linked with the strong emotion of fear. It recurs in 
attacks which are excited by stimuli, of one kind or another, 
that are associated with the perception. The patient can 
give no explanation of the meaning of this perception that 
renders intelligible his fear. There is nothing in his con- 
sciousness so far as he knows which gives a meaning to it 
and explains the fear. 

Thus, for example, C. D. was the victim of attacks of 
fear; the attacks were so intense that at times she had been 
almost a prisoner in her house in dread of attacks when 
away from home. And yet she was unable, even after two 
prolonged searching examinations, to define the exact nature 
of the fear which was the salient feature of the attacks, or 
from her ordinary memories to give any explanation of its 
origin. She remembered many moments in the last twenty 
years when the fear had come upon her with great intensity, 
but she could not recall the date of its inception and, there- 
fore, the conditions under which it originated; consequently 
nothing satisfactory could be elicited. She could consciously 
recall, however, that originally she had had attacks of in- 
definable fear of great intensity attached to no specific idea 
that she knew. These had occurred many years before 
being seen by me (in 1903), and therefore no examination 
into the content of consciousness at these moments had been 
made. During recent years, however, the fear, as she her- 
self expressed it, had become particularized, but had varied 
at different times. At one time, as she thought, it was a 
fear of illness, then of losing consciousness (or fainting), then 
of her mind flying off into space, then of being alone. She 
was not clear as to the specific nature of her fear at the time 
when she came under observation, although it was some- 
what vaguely of losing consciousness. 



246 Ideas as Determined by Unconscious Settings 

As a result of searching investigation by technical 
methods it was brought out that the specific object of the 
fear was fainting. When an attack developed, besides the 
usual physiological disturbances and confusion of thought, 
there was in the content of consciousness a feeling that her 
mind was flying off into space and a definite thought of 
losing consciousness or fainting, and that she was going to 
faint. There was amnesia for these thoughts following the 
attacks. She never had fainted in the attacks and, as it later 
transpired, had fainted only once in her life. Here then, in 
the content of consciousness, was the object of the fear in an 
attack. But the object was afterwards forgotten; hence she 
could not explain what she was afraid of. Why fainting 
should be such a terrible accident to be feared she also could 
not explain. 

The question now was, what possible meaning could 
fainting have for her that she so feared it.^ This she did 
not know. 

Now, on still further investigation, I found that there 
was always in the fringe of consciousness during an attack, 
and also during the anticipatory fear of an attack, an idea 
and fear of death. This, to use her expression, "was in the 
background of her mind": it referred to impending fainting. 
It appeared then that in the fringe or ultra-marginal zone 
was the idea of death as the meaning of fainting. Of this 
she was never aware. It was really subconscious. It was 
the meaning of her idea of herself fainting. In consequence 
of this meaning fainting was equivalent to her own death. 
She would not have been afraid of fainting if she had not 
believed, or could have been made to believe, that in her 
case it did not mean death. We might properly say that the 
real object of fear was death. 

When this content of the fringe of attention was re- 
covered, the patient voluntarily remarked that she had not 
been aware of the presence during the attacks of that idea, 
but now she realized it plainly, and also why she was afraid of 
fainting, — what she had not understood before. (It must 
be borne in mind that this meaning of fainting as a state 
equivalent to death did not pertain to fainting in general, 
but solely to herself. She knew perfectly well that fainting 



Morton Prince, M.D. 247 

in other people was not dangerous; it was only an unrecog- 
nized belief regarding a possible accident to herself.) Be- 
sides this content of the fringe of attention it was also easy to 
show that the fringe often included the thought (or idea) 
which had been the immediate excitant of each attack. 
Sometimes this stimulus-idea entered the focus of atten- 
tion; sometimes it was only in the fringe. In either case 
there was apt to be amnesia for it, but it could always be 
recalled to memory in abstraction or hypnosis. 

The content of consciousness taken as a whole, i. e., 
to include both the focus and the fringe of attention, then 
would adequately determine the meaning of this subject's 
idea of fainting as applied to herself. 

But why this meaning of fainting.^ It must have been 
derived from antecedent experiences. An idea can no more 
have a meaning without antecedent experiences with which 
it is or once was linked, than can the word "parallelopipe- 
don" have a geometrical meaning without a previous 
geometrical experience, or "Timbuctoo" a personal mean- 
ing without being set in a personal experience whether of 
missionaries or hymn books. 

I will not take the time to give the detailed results of 
the investigation by hypnotic procedures that followed. 
I will merely summarize by stating that the fear of death 
from fainting was a recurrent memory, or a reproduction 
of the content of consciousness of a moment during an inci- 
dent that occurred more than twenty years before, when she 
was a young girl about eighteen years of age. At the time, 
as the result of a nervous shock, she had fainted, and just 
before losing consciousness she thought her symptoms meant 
death. Ever since she has been afraid of fainting. 

But this again was not all. A searching investigation 
of the unconscious in deep hypnosis revealed the fact that 
death from fainting was constellated with still wider ex- 
periences involving a fear of death. At the moment of the 
nervous shock just before fainting (fancied as dying) she 
thought of her mother, who was dangerously ill in an ad- 
joining room, and a great fear came over her at the thought 
of what might happen to her mother if she should hear of 
the cause of her nervous shock and of her (the patient's) 



248 Ideas as Determined by Unconscious Settings 

death. It further transpired that the idea of death and fear 
of it was set in a still larger series of experiences. It dated 
from a childhood experience when she was eight years of 
age. At that time she was frightened when a pet animal died, 
and a fear of death had been more or less continuously pres- 
ent in her mind ever since, but not always consciously so; 
meaning that it was sometimes in awareness and sometimes 
in the ultra-marginal zone of consciousness. She had been 
able to conceal the fear until the fainting episode occurred, 
and, as she in hypnosis asserted, the fear afterward had 
continued to be present more or less persistently, although 
she was not conscious of the fact when awake, and it had 
attached itself to various ideas. Until put into hypnosis 
she had no knowledge of all this. 

The idea of death became constellated, too, in associa- 
tion with cancer, which, in consequence of certain incidents 
of her mother's illness and death, had been constantly in 
her mind, but never previously confessed, and had been the 
real meaning of her fear of illness; this last had been con- 
spicuous and puzzling to her physicians. 

Without pursuing further these and similar details, it 
must be evident that the meaning of fainting — death — 
is set in a large constellated group of experiences. 

How are we to explain the persistence during more than 
twenty years of an unsophisticated fear of fainting, a re- 
production (as memory) of the content of consciousness of 
a youthful episode.^ Or more specifically, the thrusting of 
the thought of death, as an element (meaning) in the fainting 
complex, into the content of consciousness, not to be sure 
within the focus of attention but still in the content even if 
so far outside the focus that there was no awareness of it.^ 
The theory of unconscious processes, established, as I think 
we are justified in saying, in the mechanism of numerous and 
varied psychological phenomena, oflFers an adequate ex- 
planation. As brought out in the associative memories in 
hypnosis, the youthful episode, fainting, had become constel- 
lated with a larger complex in which death was the obtrusive 
element. This complex was conserved in the unconscious 
and, as the real setting, was an active functioning process. 
It furnished the conscious "meaning" to fainting and 



Morton Prince, M.D. 249 

its affect fear. It was derived from antecedent experiences 
which were still ver^ real to her and believed in. During 
the phobia attacks a portion of the complex — fainting, 
death, fear — emerged as conscious elements — a partial 
stereotyped memory. The remainder persisted as an un- 
conscious functioning process. The content of conscious- 
ness, including therein the focus and marginal zones of aware- 
ness, would, according to the analogy of a clock, correspond 
to the chimes and hands, while the unconscious process 
would correspond to the concealed works. ^ 

I forbear to cite the analysis of other cases which give 
the same results. 

It must be borne in mind, however, that analysis, 
meaning thereby the determination of associated past ex- 
periences, cannot positively demonstrate the continuance 
of such an experience as the causal factor in a present pro- 
cess. It can demonstrate the sequence of events and, there- 
fore, each successive link in a chain of evidence, as in a 
criminal trial, or it can demonstrate the material out of 
which we can select, with a greater or less degree of proba- 
bility, the factor which in accordance with a theory — in 
this case that of unconscious processes — seems most likely 
to be the causal factor. Thus in the analysis of a bacterial 
culture we can select the one which seems on various con- 
siderations to be the most likely cause of an etiologically 
undetermined disease, but for actual demonstration we 
must employ synthetic methods, that is, actually reproduce 
the disease by inoculation with a bacterium. So with 
psychological processes synthetic methods are required for 
positive demonstration. 

For synthetic proof hypnotic methods are available 
and give more positive results. 

If a subject is hypnotized and in this state a complex is 
formed, it will be found that this complex, after the subject 

^ A certain school of psychologists I know will want to go one step further and 
postulate a repressed subconscious wish to which the fear complex is a reaction; 
but I see no justification for this. The biological instinct of fear has tremendous 
conative force, and any idea to which it is linked (as a sentiment) tends to express 
itself by this force, just as much so as a wish. Through the sophistication of the 
idea the sentiment becomes dissolved. 



250 Ideas as Determined hy Unconscious Settings 

is awakened, will determine his point of view and meaning 
of the central idea when this comes into consciousness, and 
this though the subject has complete amnesia for the hyp- 
notic experience. In this manner, if the idea is one which 
previously had a very definite and undesirable meaning 
which we wish to eradicate, we can build a complex which 
shall include that idea and yet give it a very different 
meaning, provided it is one which is acceptable to the 
subject. 

To take simple examples, and to begin with a hypo- 
thetical case, but one which in practice I have frequently 
duplicated : I hypnotize a subject, and although, in fact, the 
day is a beautifully fair one, I point out that it is, on the 
contrary, disagreeable because the sunshine is glowing and 
hot; that such weather means dusty roads, drought, the drying 
up of the water supply, the withering of the foliage, etc., 
that the country needs rain, etc. I further assert that this 
will be the subject's point of view. In this way I form a 
cluster of ideas as a setting to the weather which gives it, 
fair as it is, an entirely different and unpleasant meaning, 
and one which is accepted. The subject is now awakened 
and has complete amnesia for the hypnotic experience. 
When attention is directed to the weather it is found that his 
point of view, for the time being at least, has changed from 
what it was before being hypnotized. The perception of 
the clear sky and the sunlight playing upon the ground in- 
cludes secondary images of heat, of dust, of withered foliage, 
etc., such as have been previously experienced on hot 
dusty days, and some of the associated thoughts suggested 
in hypnosis arise in consciousness, perhaps only a few, but, 
if he continues to think about the weather, perhaps nearly 
all. Manifestly the new setting formed in hypnosis has 
been switched into association with the visual pictures of 
the environment, and has induced the secondary images 
and associated thoughts. But it is equally manifest that 
it is impossible to determine precisely how much of this 
setting is unconscious and how much conscious, although 
much of it is manifestly unconscious. 

In similar fashion I made a subject view as a cesspool 
for sewage a river which was being converted into a beautiful 



Morton Prince, M.D. 251 

water park by a dam.^ In this particular instance the main 
ideas of the setting suggested in hypnosis were intentionally 
made to enter the field of consciousness after waking, as the 
meaning of the perception. It is scarcely necessary to cite 
individual observations. In hundreds of instances for 
therapeutic purposes I have changed the setting, the view- 
point, and the meaning of the ideas of the patient by sug- 
gestive procedures, often in hypnosis and therefore without 
conscious knowledge. This is the goal of psychotherapy, 
and in my judgment the one fundamental principle common 
to all technical methods of such treatment, different as they 
appear to be when superficially considered. 

It is obvious that in everyday life when, by arguments, 
persuasion, exhortation, suggestion, punishment, or prayer, 
we change the viewpoint of a person, we do so by building 
up complexes which shall act as settings and give new mean- 
ings to his ideas. I may add, if we wish to sway him to 
carry this new viewpoint to fulfillment through action, 
we introduce into the complex an emotion which by the 
driving force of its impulses shall carry the ideas to practical 
fruition. 

It is well at this point to emphasize a fact which I have 
already mentioned, namely, that the secondary images, 
which occur in the fringe of every perception, are probably 
often determined by an unconscious complex; and as nearly all 
ideas may have different contexts or settings, and, therefore, 
various meanings, so the secondary images will vary ac- 
cording to the character of the unconscious complex which 
has been switched on at any given moment. For instance, 
the river which I see out of my window may, at one moment, 
have a setting which will present it in my consciousness 
as an object in a beautiful landscape; at another moment, as 
in the above mentioned experiment, as an unpleasant 
sewage basin, and introspective analysis will show that the 
secondary images will vary correspondingly in each per- 
ception. These images as elements in the unconscious 
complex of past experiences emerge into the fringe of con- 
sciousness. 

By way of summary, then, of what I have thus far said, 

^The Unconscious, Journal Abnormal Psychology, April-May, 1909. 



252 Ideas as Determined by Unconscious Settings 

one and the same idea of an object has a different meaning 
according to the setting, and this setting is the residua of 
past experiences. As to whether as a process it is conscious 
or unconscious, taking all the evidence in hand, a conserva- 
tive summing up would be that it may be (in simple per- 
ceptions) wholly conscious, or (in the more complex 
settings) partially conscious and partially unconscious. 
Probably in the great majority of instances the latter is the 
case. 

The Setting in Obsessions. — We are now in a position 
on this theory to look a little more deeply into the structure 
and mechanism of an obsession and thereby realize why. it 
is that the unfortunate victims are so helpless to modify or 
control them. Indeed this behavior of the setting could be 
cited as another piece of circumstantial evidence fpr the 
theory that the setting is largely unconscious and that only 
a few elements of it enter the field of consciousness. If we 
simply explain to a person who has a true obsession, i. e., an 
insistent idea with a strong feeling tone, the falsity of the 
point of view, the explanation in many cases at least has no 
or little effect in changing the viewpoint, though the patient 
admits the correctness of the explanation. The patient 
cannot modify his idea even if he will. But if the original 
complex, which is hidden in the unconscious and which 
gives rise to the meaning of the idea, is discovered, and so 
altered that it takes on a new meaning and different feeling 
tones, the patient's conscious idea becomes modified and 
ceases to be insistent. This would imply that the insistent 
idea is only an element in a larger unconscious complex 
which is the setting and unconsciously determines the view- 
point. The reason why the patient cannot voluntarily alter 
his viewpoint becomes intelligible by this theory because 
that which determines it is unconscious and unknown. He 
may not even know what his point of view is, owing to the 
meaning being in the fringe of consciousness. 

If this theory of the mechanism is soundly established 
the difficulty of correcting obsessions becomes obvious and 
intelligible. It is also obvious that there are theoretically 
two ways in which an obsession might be corrected. 

1. A new setting with strong affects may be artifi- 



Morton Prince, M.D. 253 

cially created so that the perception acquires another 
equally strong meaning and interest. 

2. The second way theoretically would be to bring 
into consciousness the setting and the past experiences of 
which the setting is a sifted residuum, and reform it by in- 
troducing new elements, including new emotions and feel- 
ings. In this way the old setting and point of view would 
become transformed and a new point of view substituted 
which would give a new meaning to the perception. 

Now in practice both these theoretical methods of de- 
stroying an obsession are found to work, although both are 
not always equally efficacious in the same case. In less 
intense obsessions where the complex composing the setting 
is only partially and inconsequently submerged, and to a 
slight degree differentiated from the mass of conscious ex- 
periences, the first and simpler method practically is amply 
sufficient. We might say that the greater the degree to 
which the setting is conscious and the less the degree to 
which it has acquired, as an unconscious process, independ- 
ent autonomous activity the more readily it may be trans- 
formed by this method. 

On the other hand in the more intense obsessions, where 
a greater part of the setting is unconscious, has wide rami- 
fications and has become differentiated as an independent 
autonomous process, the more difficult it is to suppress it 
and prevent its springing into activity whenever excited by 
some stimulus (such as an associated idea). In such in- 
stances the second method is more efficacious. It is obvious 
that so long as the setting to a central idea remains or- 
ganized and conserved in the unconscious, the corresponding 
perception and meaning is always liable under favoring 
conditions (such as fatigue, ill health, etc.) to be switched 
into consciousness and replace the new formed perception. 
This means of course a recurrence. Nevertheless medical 
experience from the beginning of time has shown that this 
is not necessarily or always the case. The technique, 
therefore, of the treatment of obsessions will vary from 
"simple explanations" (Taylor) without preliminary analy- 
sis to the more complicated and varying procedures of 
analysis and re-education in its many forms. 



254 Ideas as Determined hy Unconscious Settings 

Affects. — Here a word of caution in the interpretation 
of association reactions is necessary. In the building of 
complexes, as we have seen, an affect becomes linked to an 
idea through an emotional experience. The recurrence of 
that idea always involves the recurrence of the affect. Now 
we must distinguish between the process which determines 
the meaning of the idea and the process which determines 
the presence of the affect in consciousness. This dis- 
tinction is of fundamental importance and the failure to 
recognize it, in my opinion, has led to contrasted and op- 
posing interpretations of the same facts. 

That which determines the meaning is, as we have 
seen, the setting which provides the secondary images and 
the associated ideas, and, therefore, the point of view. 

That which determines the affect is an association or 
linking of the whole affective mechanism (including the 
physiological reactions,z.^., vasomotor, respiratory, secretory 
phenomena, etc.) to an idea. It does not give the meaning, 
but provides the impulsive force which tends to carry the 
idea to fruition. 

Now, if it is a matter of linking, it is obvious that 
theoretically the affect may be linked to (a) the unconscious 
part of the setting, or it may be linked to (b) so much of 
the idea as is conscious. That the first arrangement is also 
true in part, and therefore that the affect may be determined 
solely by an unconscious pi-ocess, I think we must accept 
as an established fact. I have elsewhere cited numerous 
personal observations derived from the phenomena of 
hypnosis, multiple personalities, dreams, etc., which seem 
to be only open to the interpretation that the emotion which 
dominated the personality was derived from subconscious 
processes (unconscious or coconscious). The emotion be- 
longing to these submerged processes emerged into con- 
sciousness.^ It was in consequence of this phenomenon, in 
the case of Miss B. that B IV wrote, "B Ts constant grieving 
wears on my nerves. It is harder to endure than one would 
believe possible. I would rather give and take with Sally 
a thousand times rather." 

^The Dissociation, pp. 262, 297-8, 324-5, 497. The Unconscious, Journal 
of Abnormal Psychology, Chap. 6, April-May, 1909. 



Morton Prince, M.D. 255 

On the other hand I think it is also true in fact, or at 
least it is a logically justified Interpretation of the facts, 
that the affect may be split off from the original setting and 
become linked with that part of the idea alone which is 
conscious. Under such an Interpretation it is not necessary 
to assume the co-operative activity of an unconscious pro- 
cess for the induction of an emotion, but the simple linking 
of the affect to a word, an object or sensation is sufficient 
to induce the emotion. In other words, the original com- 
plex has become split, the residua of the original experiences 
remain dormant and the emotion becomes linked with a 
single element of the original experience.^ 

This principle of the splitting of an affect from an un- 
conscious complex, and the linking of It to a single element 
of an experience, if it be soundly established, makes all the 
difference in the world in the mode in which we shall in- 
terpret certain psychological phenomena. Upon it depends, 
in the word-reaction tests for example, whether we shall 
interpret the emotion reaction as due simply to the associa- 
tion of the emotion with the idea of which the word is a 
symbol, or as due to an unconscious process which has been 
disturbed and which thereby induces the reaction. 

We may say then again, as I have frequently insisted, 
we must distinguish between the process which determines 
the meaning of Ideas and that which determines the affect. 
It is not a logical necessity that the original experience 
which occasioned the affect should always be postulated as 
a continuing unconscious process to account for the affect 
in association with the idea. It is quite possible, if not 
extremely probable, that in the simpler types, at least, of 
the emotional complexes, the association between the Idea 
and affect becomes so firmly established that the conscious 
idea alone without the co-operation of an unconscious 
process is sufficient to awake the emotion; just as in Paw- 
low's dogs the artificially formed association between a 
tactile stimulus and the salivary glands is sufficient to excite 
the glands to activity, or as in human beings the idea of a 
ship by pure association may determine fear and nausea, 

^The Unconscious, Journal of Abnormal Psychology, Chap. 5, February- 
March, 1909. 



256 Ideas as Determined hy Unconscious Settings 

the sound of running water by the force of association may 
excite the bladder reflex, or an ocular stimulus the so-called 
hay fever complex. So in word-association reactions when 
a word is accompanied by an aifect-reaction the word itself 
may be suflicient to excite the reaction without assuming 
that an "unconscious complex has been struck." The total 
mechanism of the process we are investigating must be 
determined in each case for itself. 

In the study and formulation of psychological phenom- 
ena there is one common tendency and danger, and that 
is of making the phenomena too schematic and sharply 
defined, as if we were dealing with material objects. Mental 
processes are not only plastic but shifting, varying, unstable, 
and undergo modifications of structure almost from moment 
to moment. We describe a complex schematically as if it 
had a fixed, immutable, and well-defined structure. This is 
far from bring the case. Although there may be a fairly 
fixed nucleus, the cluster, as a whole, is ill defined and under- 
goes considerable modification from moment to moment. 
New elements enter the cluster and replace or are added to 
those which previously took part in the composition. An 
analogy might be made with a large cluster of electric lights 
arranged about a central predominant light, but so arranged 
that individual lights could be switched in and cut out of 
the cluster at any moment and different colored lights 
substituted. The composition and structure of the cluster, 
and the intensity and color of the light, could be varied from 
moment to moment, yet the cluster as a cluster maintained. 
We might carry the analogy farther and imagine the cluster 
to be an advertising sign which had a meaning — the adver- 
tisement. This meaning would not be altered by the changes 
in the individual lamps, or it might not be even by adding 
to or subtracting from the wording. 

The same indefiniteness pei tains to the demarcation 
between the conscious and the subconscious. What was 
conscious at one moment may be subconscious the next and 
vice versa. Under normal conditions there is a continual 
shifting between the conscious and subconscious. I have 
made numerous investigations to determine this point, and 
the evidence is fairly precise, and to me convincing, that 



Morton Prince, M.D. 257 

this shifting continually occurs/ as might well be inferred 
on theoretical grounds. Nor, excepting in special path- 
ological and artificial dissociated conditions, is the dis- 
tinction between the conscious and subconscious at any 
moment always sharp and precise; it is often rather a matter 
of vividness and shading, and whether a conscious state is 
in the focus of attention or in the fringe. Experimental 
observation confirms introspection in this respect. 

In view of the foregoing we can now appreciate a fallacy 
which has been too commonly accepted in the interpretation 
of therapeutic facts. It is quite generally held that it is a 
necessity that the underlying unconscious processes cannot 
be modified without bringing them to the "full light of day" 
by analysis. The facts of everyday observation do not 
justify this conclusion. The recovery of the memories of 
the unconscious complex is mainly of importance for the 
purpose of giving us exact information of what we need to 
modify, not necessarily for the purpose of effecting the 
modification. Owing to the fluidity of complexes, whether 
unconscious or conscious, our conscious ideas can become 
incorporated in unconscious processes. This means that 
any new setting which we may incorporate in our conscious 
ideas to give them a new meaning can be made to enter into 
the same ideas contained in unconscious complexes. The 
latter is able to assimilate from the conscious any new 
material offered to it. Practical therapeutics and everyday ex- 
perience abundantly have shown this. I have accomplished 
this, and I believe every therapeutist has done the same 
time and again. We should be cautious not to overlook 
common experience in the enthusiasm for new theories and 
dramatic observations. The difficulty is in knowing what 
we want to modify, and for this purpose analytical investi- 
gations of one sort or another are of the highest assistance, 
because they furnish us with the required information. If 
we recover the memories of the unconscious complex our 
task is easier, as we can apply our art with the greater skill. 
When we speak of a setting to an idea we are not en- 
titled to think of it as a sharply defined group of ideas, or 

^I am excluding conditions like split personalities, automatic writing, etc., and 
refer rather to normal mental processes. 



258 Ideas as Determined hy Unconscious Settings 

sharply limited unconscious process. When we identify 
it with the residua of past experiences we are not entitled 
on the basis of exact knowledge to arbitrarily make up a 
selected cluster of residua which shall exclude those and 
include these residual elements of antecedent associated 
experiences, and dogmatically postulate the composition 
of the complex which we call the setting. Analysis by the 
very limitations of the method fails to permit of such 
arbitrary selection, and synthetic methods are not suffi- 
ciently exact for the purpose. All we can say is that from the 
'/ residua of various past experiences a complex is sifted out to 
/ become the setting. And even then no process is entirely 
autonomous and entirely removed from the interfering, 
directing, and co-operative influence of other processes. 
Even with simple and purely physiological processes, such 
as the knee jerk, this is true. Although the knee jerk may 
be schematically conceived as a simple reflex arc involving 
the peripheral nerves and the spinal cord, nevertheless 
other parts of the nervous system — the brain and the 
spinal cord — provide co-operative processes which take 
part, and under special conditions take a very active part, 
in modifying the phenomenon. While we are justified 
for the clarifying purposes of exposition to schematize the 
phenomenon by selecting the spinal reflex as the predomi- 
nant process, yet we do not overlook the co-operative pro- 
cesses which may control and modify the spinal reflex. If 
this is true of purely physiological processes, it is still more 
true of the enormously more complex processes of human 
intelligence. 

We may say, then, not only that with our present 
knowledge and our present methods we are not able to pre- 
cisely diflFerentiate the settings of ideas, but that it is highly 
improbable that settings as complexes of residua are with 
any preciseness functionally entirely autonomous and re- 
moved from the influence of other associative processes. 

We need further investigations into the psychology 
and processes of settings, and until we have wider and more 
exact knowledge it is well not to theorize and still more 
not to dogmatize. It is an inviting field which awaits the 
psychologist. 



A CLINICAL STUDY OF A CASE OF PHOBIA: 
A SYMPOSIUM' 

BY MORTON PRINCE, M.D., AND JAMES J. PUTNAM, M.D. 

INTRODUCTION . 

A few words in explanation of the symposium which follows is desirable. The 
■object of this symposium was to obtain a presentation and discussion of the ex- 
isting divergent views regarding the pathology of anxiety states held by different 
students of psychopathology. It was thought by the Council of the American 
Psychopathological Association that if a specific case of phobia or anxiety state were 
studied independently by two clinicians holding divergent views regarding the 
pathology of anxiety states, the differences in their views would be more concretely 
illustrated and more precisely formulated than by any discussion of anxiety states 
in general. In discussions of the latter kind the tendency is to wander over a large 
field of inquiry and to meet at very few points. 

Accordingly it was arranged that a report of the same case should be made 
independently by Dr. Putnam and Dr. Prince, each making his study from his 
own point of view, without consultation with the other. The case selected was one 
which had been under the care of the former for a long period and which the latter 
studied for the purposes of the symposium and which, it also should be said, had 
been frequently observed by him, although never under systematic treatment at 
his hands. The case is also well known to quite a number of Boston physicians 
(members of the Association), under whose care the patient had been at different 
times.^ The treatment in every instance had met with indifferent success. The 
case, a difficult one, is therefore well adapted to such a symposium. 

Not the least interesting point, which becomes apparent from a study of these 
two reports, is the different kinds of facts elicited by the two studies — what would 
seem bound to be the case when two persons influenced by different theories ex- 
amine the same patient. Herein probably also is to be found the basis for much of 
the divergence of views in psychopathology. 

Ed. 

I 

REPORT BY MORTON PRINCE 

THE patient is an unmarried woman forty-one years 
of age, physically hale and hearty and of a robust 
type. Mentally she is normal with the exception 
of certain obsessions, the chief of which, a phobia, 
is the subject of this symposium. I refrain from describing 
her temperament and mental characteristics because pro- 

^Read before the Annual Meeting of the American Psychopathological Asso- 
ciation, at Boston, May 29, 1912. 

259 



260 A Clinical Study of a Case of Phobia 

verbially no two persons can agree in forming judgment 
upon such characteristics. I will merely say that she con- 
spicuously belongs to what is commonly regarded as the 
consciously asexual type. 

The attacks from which she suffers and which have 
been making her life intolerable during the past eight years 
do not always present the same characteristics, but exhibit 
certain sub-varieties, each, from the point of view of psycho- 
genesis, being of great importance. I shall first describe 
the character of the major attacks, then the sub-varieties, 
and finally analyze the individual symptoms which make up 
the syndrome of each. 

First. A feeling of what she calls "unreality" because 
of certain subjective sensations, some of which seem to be 
primary and some secondary. These may be analyzed 
into 

(A.) A consciousness that she does not feel the air 
about her and particularly on her face, of her "inability to 
feel the air," and hence that the air is not real and that she 
cannot breathe the air because there is none to breathe. 
There is a sort of struggle to get air. This unreality of air 
is always the first symptom of the attack. 

(B.) A sensation of queerness of the body difficult to 
describe. It is a sensation that her hands and feet are 
flying off. In attempting to describe this she likens it to the 
explosion of a pinwheel in which everything flies off from a 
center. Apparently a part of this sensation is a "feeling" 
in her body from the waist up (not down) and always in the 
left side of the hypochondrium. It is a " pulling out feeling," 
— a "horribly disagreeable feeling." On one occasion she 
likened it to an accordion being pulled out. At this point 
in the attack (to quote her words) a "conflict comes in 
trying to make myself see things normally, and as my mind 
refuses to do so I get into a condition of * unreality.' " 

(C.) This condition changes to a feeling of "wildness" 
that she must rush, but there at once comes a feeling of 
"paralysis" or inability to "rush": she can't rush. For ex- 
ample, as happened in a recent attack, this syndrome 
developed as she was leaving a street car. She felt that she 
must rush to a neighboring house, but she couldn't. She 



Morton Prince, M.D. 261 

would like, too, at times, to reach out and touch objects to 
assure herself, but she can't. 

Second. A confusion of thought. 

Third. Fear with the usual somatic disturbances, 
palpitation, vasomotor disturbances, tremor, etc. 

Fourth. Certain visualizations of herself in a con- 
vulsion. 

Fifth. There is the usual anticipatory fear of an attack, 
and also, as is customary, this fear may excite an attack. 

Sixth. In my experience whenever an attack has been 
analyzed it always could be traced to some stimulus either 
from the environment or some thought which immediately 
excited it. Frequently this stimulus is forgotten, but I 
have always found it possible to bring the memory of it back 
to consciousness. 

Now, when we come to examine into the attacks we 
find that they are not all alike but present certain specific 
sub-varieties. Yet there is one feature common to all which 
I shall call for the sake of brevity, "the unreality of air," 
with the peculiar somatic sensations I have described. Hence 
they may be called, from one point of view, "unreality 
attacks." But that term, so far as it is applied to the attacks 
which are the subject of this symposium, is a flagrant mis- 
nomer. Analysis shows the attacks are of two varieties. 
First, without fear; these she calls '^passive unreality,'''' and 
are the unreality attacks proper. Second, with fear; these 
she calls '^ panic,^'' and are the phobia attacks alone. 

In each kind of attack she frequently has visualizations 
of herself in a convulsion. For example, on the day on which 
these notes were made, while in my library waiting to be 
seen and looking out of the window at the Charles River, 
she had an attack of "passive unreality." She visualized 
herself in a convulsion: actually saw herself fall on the floor 
of the library and going through certain contortions which 
she likened to the boy in a fit in Raphael's picture of the 
"Transfiguration." In this visualization her vision-self 
was frightened (though she herself was not) and was scream- 
ing and struggling for air and seemed to be trying to get 
itself back to normality. At the same time when she had 
this visualization she experienced the peculiar "pulling 



262 A Clinical Study of a Case of Phobia 

feeling" from the waist up, which I have described above.. 
This visualization does not amount to an actual vision, and 
she insisted definitely that she was without fear in this 
attack. This visualization of herself in a convulsion as a 
part of the attack she has frequently experienced, particu- 
larly "seeing herself" thus in some place where she couldn't 
obtain help: for instance, in an electric car or railroad 
train, or in some lonely spot off at a distance, or on an ocean 
steamer, or on a mountain, etc. 

We see from the above that all the attacks do not in- 
volve fear, that is, are not a phobia, but only the major 
attacks involve fear and are a phobia. This is an important 
distinction both for psychogenesis and for symptomatology. 
It is still more important for understanding what the problem 
is that we are trying to solve. It is the major attack with 
fear that is the anxiety state, not the unreality-of-air syn- 
drome. The latter, as we shall see, occurred and recurred 
long before the phobia developed. // it had not been for 
other and entirely independent experiences there would not 
have been any anxiety state but only the benign unreality com- 
plex which is, so common in psychasthenic conditions . 

Now, what is this fear which is the obsession.^ 

When we examine more closely into the nature of the 
fear we find that it is always predominantly a jear of in- 
sanity. This she always insists upon, but when we inquire 
still more deeply into it we find that there is another fear, 
that of death. There is a fear that either death or insanity 
awaits her, but the predominant fear is always insanity. 
Always when questioned as to the nature of her fear she 
first answers "of insanity," but later, after introspection, 
she adds "death also," recognizing at the same time that the 
former was the predominant one. 

The case, then, which is the subject of this symposium 
is the phobia of insanity and death. Let us not forget that. 
It is this alone that we are called upon to interpret. 

Now let us examine each of the main symptoms of the 
phobia attacks with a view to determining its genesis and 
relation to the attack. 

Unreality of Air. The first attack of what we have 
called unreality of air occurred nine years ago, when she 



Morton Prince, M.D. 263 

was thirty-two years of age, while walking along a street 
in the slums. (The memories of this attack and also of the 
other experiences of her life which I shall make use of were 
to a large extent recalled in a condition of abstraction. 
This I wish to have understood in the course of this account 
of the case.) In this attack she was walking with four girl 
friends, talking pleasantly. " Suddenly," to use her language, 
"I felt unreal. It was unreality about air." 

Question. "What do you mean by unreality about 
air.?" 

Answer. "The question in my mind is, what is air 
and how can a thing be all around you which you cannot 
feel.? I cannot feel the air. I am not conscious of it. The 
feeling comes of trying to make myself feel the air against 
my face. I am walking along trying to get rid of this thought 
about air, — trying to distract myself by the sights on the 
street." 

Question. "Does the street around you seem real.? Do 
you yourself feel real.?" 

Answer. "Perfectly. The feeling that I have is that 
I cannot feel the air. The pavement is the pavement, the 
street is the street, I am I, but I cannot feel the air." 

Question. "Why are you calling it 'unreality'.? You 
describe only a lack of feeling.?" 

Answer. I am calling it unreality because I cannot 
feel it and I have never thought of it like that before. It 
just comes to me now." 

Question. "You mean then that what you are de- 
scribing is only an inability to feel the air.?" 

Answer. "Exactly! And I never thought of it that 
way. I thought it was a thing of the mind. We cross 
Shawmut Avenue and walk along towards the Club [a 
Settlement Club] and get into the house where I am not 
trying to feel the air, and it goes. The attack is over." 

Question. "What is your mental state.? Anxiety, 
curiosity, or what.?" 

Answer. "Trying to look into the mysteries of the 
world, as to what air is and the planets, and that sort of thing. 
In other words, it comes to me now that it is largely trying 
to investigate and not succeeding, and from the fact that I 



264 A Clinical Study of a Case of Phobia 

do not succeed it makes mental conflict. It is in this way: 
I try to find out what something is like, so to speak, and I 
cannot find out what air, for instance, is like, and because 
I cannot give myself a satisfactory definition or answer 
it makes conflict. I see now quite clearly certain things. 
It has come to me that what it is is more or less of a temper 
fit, as if you were very angry and wanted to strike some one 
and you do not strike him. It is the same way about this. 
I want to feel the air and I cannot, and it is a mild temper 
fit. I do not think it really is anger. It is annoyance^ 
irritation. In other words, it is trying to do something that 
you cannot. I have since had repeated attacks of the same 
kind of unreality, but they never frightened me, only annoyed 
me. First it is a feeling of annoyance, later, in the major 
attacks, comes the panic." 

During the year following this attack she frequently 
had similar benign attacks of "passive unreality," as she 
does now. They were never conjoined with fear of insanity 
until a year later, but this fear, as we shall see, had 
occurred years before the development of the passive un- 
reality attacks. 

First, let me say, the exact psychogenesis of this meta- 
physical complex, if I may so term it, about air I have not 
been able to unravel, owing to the limited number of oppor- 
tunities which the patient offered me to study the case for 
this symposium. What I should like to know is what 
antecedent thoughts about air preceded the outbreak. 
What ideas has she had about the mysteries of life.^^ What 
antecedent thoughts or what stimuli thrust this metaphysical 
query into a pleasant conversation.^ What was she thinking 
about at the time.^ What was the exact nature of the con- 
flict that resulted .^ What emotions were involved .^ 

However, whatever the psychogenesis of the air phe- 
nomenon, it is immaterial to this case. As I have said, 
it is not the obsession under discussion, although it later 
on by accident became a factor in the complex of the true 
phobia. 

Now the phobia in this case, as I have already pointed 

* At different times her thoughts had dwelt upon various metaphysical 
problems of life, problems to which she could not find a satisfactory answer. 



Morton Prince, M.D. 265 

out, is not of the "unreality of air," but of insanity and 
death. Why does this patient have these obsessing fears? 
No one likes insanity and no one likes death, but we do not 
have an obsessing fear of them as catastrophies likely to 
affect ourselves particularly in the immediate present. A 
fear of insanity involves, of course, some particular con- 
ception of insanity as affecting oneself. No one can have 
such an idea, nor can any one have a perception of himself 
as an insane person, or one likely to become insane, unless 
he has had some past experience to form a setting which 
has given a particular meaning to that idea; and likewise 
with a perception which means the likelihood of death from 
harmless attacks. 

The question then comes, why does this patient have a 
fear of insanity, and why does she have a fear of death .^ I 
set out in my investigation to discover answers. 

Why the Fear of Insanity. Five years before the 
first unreality attack, and fourteen years ago when she was 
twenty-seven years of age, she suffered from supposed "liver 
trouble "of some kind and jaundice. During this condition 
of jaundice she was very much depressed. It was during 
this illness that she first acquired the fear of insanity. She 
never thought of going insane until this liver trouble de- 
veloped when her mind, as she expressed it, "became 
peculiar." She thought she "was in for melancholia." She 
could not shake the gloom, and her thoughts became 
fixed upon death and a future life. It is important to note 
that when we inquire more closely into this idea of a 
future life it is found to have no ordinary or metaphysical 
meaning but the very specific one of hell. It was the 
medieval conception of hell, and a future life to her meant 
the place, Hell. When this idea came into her thoughts 
she actually visualized the inferno, saw the inhabitants 
undergoing tortures of all kinds such as are pictured 
in medieval paintings. Death and hell became equiv- 
alent in her mind and she feared both. 

During this depression, with her thoughts fixed on 
death and hell, she thought she was insane or would go 
insane. The patient recalls a large number of specific 
memories of this period, the sum and substance of which is 



266 A Clinical Study of a Case of Phobia 

that in consequence of the depression induced by the liver 
disease she underwent various mental conflicts trying to 
reason herself out of her depression and her gloomy thoughts 
of death and a future life in hell. As a result of these argu- 
ments with herself she would have spells of cheerfulness 
which would last some little time. 

"I remember," she says, "reasoning with myself in one 
of these fits of depression and saying that there was some- 
thing radically wrong with me or I could not have such 
thoughts; radically wrong with my body, which then I let 
myself believe was affecting my mind. I never thought in 
those days that it was the other way around. 

"I remember going to a funeral just at this time, and 
during the service being almost speechless with gloom and de- 
pression. I also remember driving to the cem.etery, Forest 
Hills, and being scarcely able to talk with the people in the 
carriage, I was so depressed with these same thoughts. I 
remember thinking then that it was my body that was up- 
setting my mind, that my mind was really upset or I could 
not have such thoughts. I thought that if I dwelt any 
longer on this one subject it would be fixed upon me and 
then I couldn't shake it. I did not fear anything like a 
fit or unconsciousness, but I did believe that if I dwelt on 
this thought I would never shake it, that I would have it 
for the rest of my life." 

Question. ''What do you mean by 'upset'.?" 

Answer. (Patient thinks for a moment, then exclaims 
in surprise:) "I see it now! I never saw it before! It has 
come to me ! I thought that if I dwelt on one thought, if I 
couldn't get a thing out of my mind, it was insanity, that 
part of the brain was diseased: that thought was always 
there. I see now there is no danger of insanity at all." 

Here then, in this period, we have the origin of the fear 
of insanity, a fear growing out of the fact that she was fixing 
her thoughts upon one idea, that of death and a future life 
in hell accompanied by visualization, an idea which she could 
not get out of her mind, and also growing out of the belief 
that this thought was insanity. She perceived herself as 
an insane person or, even at best, a person who was doomed 
to become insane. The idea of insanity and of herself as an 



Morton Prince, M.D. 267 

insane person had a very definite and peculiar meaning for 
her, and this meaning, as we have seen, must be due to a 
setting. What was the setting which gave this peculiar 
meaning to insanity? To learn this we have to go still 
further back, to a time when she was twenty-three years of 
age, eighteen years ago. At this period an artist friend told 
her a story about some one, a friend of his, who went insane 
after dwelling on one subject, and then he added, "That 
is a very dangerous thing to do, — it causes insanity. The 
mind becomes fixed on one idea and cannot throw it oflF, 
and that is insanity." Here we have the experience that 
furnished the setting that gave the mtcaning to her idea of 
insanity. And now, finding that she herself was doing this 
very thing, dwelling on the idea of death, etc., she per- 
ceived herself as an insane person or one doomed to insanity. 
It goes without saying, of course, that the fear was 
aroused by her realization of her situation and became linked 
to her perception of herself, and thus was formed the phobia 
of being insane or becoming insane. It only needed a favor- 
ing occasion to link these two perceptions to the unreality 
attacks to have these attacks transformed into a phobia of 
insanity. Before reciting the episode which brought about 
this linking, I will give in detail one or two episodes which 
give an idea of the degree to which fear of insanity had 
developed before the final amalgamation took place. 

When asked to think of insanity and narrate any mem- 
ories that came to mind she said: 

"I remember visiting at Belmont and driving by the 
insane asylum. I heard a tale of a woman who had gone 
insane and was there; and another tale of a man who thought 
he was a dropped egg on toast, and the horror of mental de- 
rangement came upon me then very strongly and I immedi- 
ately focused my mind on myself and imagined that I might 
be there some day. I had a feeling of timidity, suffocation, 
clutching. The memory came into my mind that my uncle 
had been insane and that it might be inherited. Then came 
a quite strong conviction that I might be right in this sup- 
position. I then said, *No, this is nonsense; you are badly 
jaundiced and it is your liver and not your brain that is 
wrong.' The next day, in Belmont, I went over the same 



268 A Clinical Study of a Case of Phobia 

thing in my mind. Then a day or two afterwards I heard 
of two families out there where there was insanity and 
where it had affected each generation, and one woman, who 
was extremely peculiar. I went to her house and I came 
away weighted down with the horror of mental derangement, 
so weighted down that it seemed as though there were a 
load upon me that I couldn't get rid of, and I argued then, 
*You are jaundiced; this is nonsense; it is you liver.' (Dr. 
F. said, and I believed him, that anybody who was jaundiced, 
badly jaundiced, would of necessity have depression and 
queer thoughts.) 

^'Then, a few days later, I remember going out to walk 
with some children and thinking how wonderful it was that 
they could be so happy, particularly some of the children 
where there was insanity in the family, and trying to analyze 
their minds and see if I could find a trace of anything pe- 
culiar. I could not detect anything, and then I argued with 
myself, 'Well, there really is insanity in the family there 
and these girls are not thinking about it and they seem 
perfectly happy. Now, I haven't really got that in my 
family, so there must be something the matter with myself.' 
I was depressed all this time. 

"About this same time a neighbor came to the house 
whose sister had died of cancer of the liver, and she told 
me that my symptoms were exactly like her sister's, and that 
turned my mind from the idea of insanity for a time, as I 
realized that the seat of my trouble, the whole of it, was in the 
liver and I cheered up and got away from the insanity idea 
for a spell." 

Why Her Thoughts were fixed on Death and Hell 

DURING THE " LiVER DEPRESSION " AND WHY THE FeAR OF 

Death. We have then, up to this point, a person who per- 
ceived herself during attacks of depression from organic 
disease as an insane person or as a person doomed to become 
insane, with resulting fear because her mind was fixed upon 
one idea, that of death and the medieval conception of hell 
as the future life that awaited her. 

Why was her mind fixed on this particular idea at such 
times .^ The idea of death, also, etc., was linked with fear 
and loomed up as a fearful possibility. Why did death 



Morton Prince, M.D. 269 

seem so fearful, or rather, why this conception of a future 
life? There must have been some antecedent experience 
which gave origin to the fixed idea, and there must have been 
some setting which gave the peculiar meaning to death 
and a future life, and this setting, too, must have been derived 
from past experiences. When we go back still further to a 
time when she was sixteen or seventeen years of age, we learn 
what these experiences were and what became the setting. 
At this youthful age, while living in Germany, she had an 
attack of catarrh of the bowels and was very anemic. I 
will quote her own description of her mental condition at 
this time: 

"I was sunk down with gloom and did not know the 
meaning of the gloom. I remember reasoning with myself 
as I walked along the street that I felt unnatural. I seemed 
to be in a sort of tomb, I should think. I remember reason- 
ing that I was not well and hence this queer feeling. I 
reasoned that there was a reason for it. I came out of that 
and got rid of the catarrh of the bowels, and was as cheerful 
as a lark. / do not remember at that time fearing for my mind^ 
(Note that notwithstanding the depression there was no 
fear of insanity at this time.) 

"Now, while in this condition of depression, a friend of 
my father's came to see us one afternoon. He was talking. 
He had just come from Italy, I think, and was describing 
Michelangelo's 'Last Judgment,' or else he was describing 
his early childhood, but I know he had come from Italy and 
was talking about the old-fashioned ideas of heaven and 
hell, and I was listening. I was only a young girl about 
sixteen or seventeen years of age. I wasn't well. His de- 
scription was very realistic, and the idea of death got into 
my head and I visualized it and people being punished. 
Something like Dante's Inferno. I couldn't throw it off. 
This was the first obsession. The idea of hell. I thought 
that I might go there. I had a fear of going there. He de- 
scribed this very graphically. He was an exceedingly in- 
teresting man. We all sat around while this talk was going 
on. The terror of hell came to me then. I wasn't well 
enough to throw it off. From that grew the idea of death, 
paration, eternity. And that was the gloom that I had later 



270 A Clinical Study of a Case of Phobia 

with the jaundice. The same gloom came back. The same 
ideas of hell.^^ 

So we see that death became equivalent to hell. 

We have now the setting which gave the meaning to 
the idea of death and a future life, the whole, with the 
depression forming a complex. The recurrence of the de- 
pressed state from organic disease on well-known psycho- 
logical principles (alteration of personality) resurrected the 
previous fixed ideas of that state. So we learn why she was 
afraid of death, why she had certain specific fixed ideas 
during the state of depression from jaundice, and why she 
was afraid of insanity. 

The idea and fear of death and hell were also in- 
corporated in the insanity phobia, inasmuch as it was 
the fixation of the former that was, in her belief, insanity. 

There remains, however, the question as to how the 
fear of insanity and death became linked to the attacks of 
unreality, transforming them into "panic" or anxiety 
attacks. This did not happen until six years after the fear 
of insanity developed, or eight years ago, when she was 
thirty-three years of age. 

How THE Unreality Attacks became a Phobia of 
Insanity and Death. The unreality attacks became a 
phobia of insanity and less intensely 'of death in the fol- 
lowing way: It happened eight years ago when she was 
thirty-three years of age, during the time when she suffered 
from jaundice and depression and feared she was doomed 
to insanity. (These attacks of jaundice, by the way, which 
had been supposed to be due to liver trouble continued until 
four years ago, when she was operated upon, when the at- 
tacks ceased.) Please still bear in mind that up to this 
time the "unreality attacks" were in no sense a phobia. 
They had no setting to give them a meaning that she should 
fear them, but as a result of the experiences I am about to 
relate they acquired a setting which gave them such a mean- 
ing, a meaning that they might lead to insanity or death, 
both of which she feared. Her sole phobia of insanity up to 
this time pertained to the depression which accompanied the 
jaundice. 



Morton Prince, M.D. 271 

Well, one day she was in her room preparing to go to 
Europe and she had an attack. It began as a simple un- 
reality attack. Her trunks were nearly packed; it was a 
warm day in April. "It didn't seem as though air were 
coming in, although the window was open." She "couldn't 
feel the air." At the time she "had a headache; felt strange; 
took a moderate dose of bromo-seltzer or something of that 
sort." Then she "felt queerer." From that it "went on 
to a bad panic of fear and [she] went up on to the roof to get 
air, but there didn't seem to be any," and she "had a 
strong conviction that it was not safe for her to go to Europe 
because she was going out of her mind. This was the fear." 

The details of the mental processes that had led from 
the feeling of "unreality" to the "panic" and the fear of 
insanity are important, and I will let the patient tell them 
in her own words. (It is to be remembered that as she re- 
calls these memories she is in a state of abstraction and in 
imagination visualizes herself in her room in the midst of the 
attack and describes each thought and feeling as it recurs.) 
"I am in the room and I cannot make air real. I cannot get 
that one impression out of my head. I feel strange. I 
have taken the medicine and feel queerer. I feel so strange 
that I can feel it in my hands. I have a sort of contraction 
of my hands, a contraction of my body; my legs stiffen. 
A curious rushing of blood makes my heart palpitate. The 
feeling is that of blood rushing to my head. I am trying to 
feel the air. I cannot. I am only conscious of my body. 
Everything looks perfectly natural. I am not unconscious 
of the externals, but I am more conscious of the internals, so 
to speak. The room is natural and my body is natural, only 
I do not feel the air and I struggle to feel it. This struggle 
causes panic. I am trying to make a satisfactory explana- 
tion to myself about air, but I cannot do it. I get annoyed 
and feel the annoyance because it looms up such a mystery in 
my mind — causes the fear of going straight out of my head. 
I am trying so hard to solve the mystery which I cannot do. 
[Panic follows in such force that] I think I am going out of 
my mind and that is my real fear. My thoughts are so com- 
plicated and bewildering and cannot be reconciled one to 
another that I think I am going out of my mind. 



272 A Clinical Study of a Case of Phobia 

"It Is the thought of not being able to satisfy my mind 
about air that works up, and works up, and works up, until 
panic culminates; panic which is fear because I cannot 
satisfy my mind. My thoughts are so complicated that I 
fear I am going out of my mind." 

Question. — "What do you mean by working up?" 

Answer. — "The only way I can explain it is that it is 
like trying to make sense out of a puzzle, and you cannot 
do it, or taking something in music and trying to memorize it, 
thinking you have it, finding you cannot get it, then getting 
into a stew thinking that if you cannot get it in a certain 
time you never will be able to play. When a person gets 
where he cannot make things in nature reasonably clear this 
inability to solve the problem causes the fear of losing his 
mind. Feeling such a condition it seems that I am losing 
my mind. I am afraid. I know all the time that what I am 
trying to make out is perfectly absurd and nobody else is 
trying to make it out. Therefore, because I alone am trying 
to do this comes the thought that that is insanity. As an 
insane person might try to solve something nonsensical. 

"After going on the roof I thought I was losing all con- 
trol. I visualized myself struggling^ in a fit, my mind leaving 
my body. I felt my mind going right out of my head, my 
arms going out, a separation of my limbs, and trying to hold 
myself together, and a desire came upon me to run and 
knock into something. The memory is that I wanted to run 
and knock into something thereby making reality of feeling. 
Absolute confirmation came upon me that the calamity was 
before me of losing my mind and I felt that something 
calamitous was going to happen. I seemed to have it in- 
born that I must not go to Europe. I remember that a 
calamity was going to befall me ever since the liver illness, 
when I went to Belmont to convalesce." 

This was the first attack of unreality with "panic" 
that she had ever had; the previous attacks had always been 
benign and without fear. Ever since this attack the fear of 
insanity has been incorporated with the syndrome of 
unreality. 

Three days later she had another attack of panic while 
crossing the ocean and sitting on deck. "The feeling of a 



Morton Prince. M.D. 273 



mental and physical cyclone came over me, and during that 
cyclone there came the almost conviction of suddenly going 
out of my mind; so much so that I left my steamer chair, 
went downstairs to my stateroom, took a snail dose of aro- 
matic spirits of ammonia and tried to make myself believe 
that I was not going out of my mind, although I felt entirely 
out. (By cyclone I mean an attack of unreality and panic.) '^ 

Shortly after this she had another attack in the train in 
London, accompanied by a visualization of interest. In 
this attack she fell on the floor of the car and thought she was 
dying, — as she expresses it, "all the strength went out of my 
body," — and before she fell she had a visualization of her- 
self in a convulsive attack and dying. (At this time she 
was convalescing from a physical illness, supposed to be 
abcess of the liver or some intestinal trouble, and it is probable 
that the attack was complicated by physical causes and 
possibly fainting.) 

It is obvious that since the first attack in her room the 
fear of insanity had acquired an additional meaning. Pre- 
viously this had been linked only with the fixed idea of death 
and hell, which arose only during the jaundice state. Now 
it was revived by and became linked to bewildering, irrec- 
oncilable, absurd thoughts, conflicts, feelings, and disso- 
ciations in which the unreality syndrome culminated and 
was apt to culminate. This mental outbreak confirms her 
former belief that she was doomed to insanity and again 
under her condition she perceives herself as an insane person. 

(I pass over a deeper analysis of the state of dissociation 
which is undoubtedly present and probably induced by the 
conflict described.) 

Further, the previously benign unreality syndrome, 
having now become incorporated in an insanity setting, had 
thereby also acquired a new meaning. From this time on 
the insanity complexes — whether conscious or unconscious 
it is not necessary for us now to consider — determined 
a new point of view, made her perceive her unreality attacks 
as incipient insanity, made her perceive herself as either 
insane in these attacks or as likely to become insane if the 
attacks continued. She now became apprehensive of the 
unreality attacks because they meant insanity. 



274 A Clinical Study of a Case of Phobia 

Fear of Death in the Attacks. — How about the 
fear of death which, as we have seen, was also incorporated 
in the obsession? Why did she fear death in the attacks? 
In seeking the complex which was the setting that originally 
gave meaning to her fear of insanity, we found that it was 
intimately associated with the fixed idea of death and a future 
life in hell, a la Michelangelo's "Last Judgment." This 
fixed idea had been incorporated in the insanity setting for 
many years, and it was the idea which originally was re- 
sponsible for her perception of herself as an insane person, 
and therefore was bound to recur when the insanity phobia 
was stimulated. 

But there was another factor which determined the re- 
currence of the idea of death in the phobia attacks, and gave 
the meaning to her perception of the attacks. We must go 
back to the time when she was twenty-three years of age. 
At this period her father had convulsions which followed an 
apoplectic attack, and which she believed (possibly rightly) 
to be due to Bright's disease. They made an impression 
upon her. She became apprehensive that some time in the 
future she would have Bright's disease and convulsions. 
From the age of twenty-three to thirty-three (when the 
unreality attacks developed) this thought had apparently 
dropped out of her mind. Now, in the process of recovering 
associative memories she stated that she "knew that people 
who had convulsions became unconscious" and that she 
always had a horror of ''being unconscious and of being 
buried alive"; she believed that "being unconscious might 
mean death and being buried alive." This idea had become 
incorporated in the setting of her perception of her attacks 
in the following way, and gave the perception a correspond- 
ing meaning, as she herself analyzes it: "The unreality now 
had become equivalent to losing my mind; unreality was 
followed by struggle to get air and fright; fright also led to a 
struggle; struggle was equivalent to convulsions, convulsions 
culminated in unconsciousness and unconsciousness meant 
death." (It is interesting to note that in the visualization 
of herself in convulsions she describes herself "struggling 
for air" and at the same time described the visionary self 
as in a fit. The two terms in her thoughts are synonymous. 



Morton Prince. M.D. 275 



She had also visualized herself as dying in convulsions. 
Hence it is clear that the idea of struggling, convulsions, un- 
consciousness, became equivalent to death and a life in hell, 
and the fear of death became linked with the unreality 
syndrome and the unreality complex, — the whole becoming 
a recurrent psychopathic state or obsession. 

Mechanism of the Visualization. — This brings us to 
the consideration of the interesting phenomenon of the visu- 
alization which is an element in both the passive and panic 
attack. We open up the large subject of hallucinations 
which, of course, I can only touch upon very superficially 
here, resting content with merely stating my interpretations. 
The visualized images of herself in convulsions are, as I 
interpret them, analogous to the secondary images which 
take part in perception. The process is similar to that of 
dreams and visions in general. The antecedent thoughts 
incited in the first place by her apprehension of inheriting 
Bright's disease and convulsions from her father, and in the 
second place from her conception of the unreality syndrome, 
as a state which might possibly end in convulsions, now func- 
tioned unconsciously and induced the secondary images as a 
quasi-hallucinatory expression of the thoughts. This un- 
conscious process therefore, on the one hand, took part in 
the setting which determined^ the meaning of the panic 
attacks and, on the other, determined the quasi-hallucina- 
tory phenomena. How far the settings which gave meaning 
to the other ideas which I have already considered were con- 
scious, or unconscious, is a secondary question which does 
not come within the scope of this symposium. 

Fear of Railroad Trains, etc. — There is one sub- 
sidiary phenomenon on which before closing I wish to say a 
few words, as it is one to which I give an entirely different 
interpretation from that which is given to it by Dr. Putnam 
and others. I refer to the fear which this patient experienced 
of traveling in trains, going into lonely places, walking along 
the street alone, or entering places like a church, a theater, 
etc. Some of these fears have been called agarophobia, 
claustrophobia, etc. Almost all, if not all, patients suffering 
from phobia have fears of this kind. They occur in people 
of all types and characteristics, amongst the normally self- 



276 A Clinical Study of a Case of Phobia 

reliant as well as amongst the timid. The ordinary concep- 
tion of this fear to my mind is entirely erroneous. There is 
no fear, properly speaking, of an open place, or of a closed 
place, or of a train, or of a theater. The true fear is of having 
an attack in a situation where, owing to the circumstances 
of the environment, the patient cannot obtain relief. The 
mental condition is exactly the same as that of a person who 
because of having heart disease or epilepsy is afraid to ride 
on a bicycle, or is afraid to be in a situation where, if a heart 
or epileptic attack should occur, assistance could not be 
obtained. These patients with phobias all have anticipa- 
tory fear of an attack, and this is particularly intense in 
anticipation of a situation where help in an attack cannot be 
expected. None of these phobia cases is afraid to be in these 
situations provided he is accompanied by a physician, or a 
person in whom he has confidence. The patient under 
discussion, for example, had not the slightest fear of traveling 
in a train if she is accompanied by her physician. The 
patients who are afraid of being in a church or in a theater 
are simply afraid because they realize that if an attack de- 
velops they cannot get out, considering the formal condi- 
tions that exist. Such a patient can comfortably sit in the 
last seat of a church or of a theater, but not in the front row 
or where he would be closed in by other members of the 
audience. This is the whole meaning of this fear, as I have 
satisfied myself again and again. There is therefore no 
symbolism nor abstruse or subtle meaning to the fear. 



A CLINICAL STUDY OF A CASE OF PHOBIA 

II 

REPORT BY JAMES J. PUTNAM 

THIS paper attempts a brief study of the case of a 
lady, now about forty years of age, mainly char- 
acterized by phobias and compulsions, differing 
from one another, I believe, less in principle than 
in detail, and, at any rate, closely interwoven with one an- 
other. 

The main object of the discussion is to bring into relief 
the diflFerence between Dr. Prince's views and mine, with 
regard to the general principles here at stake, and for that 
purpose this history, used as a text and illustration, will 
serve sufficiently well. I wish it to be understood, however, 
that the doctrines here advanced rest on evidence furnished 
bit. by bit through the prolonged studies of many different 
observers, and depend but little on the necessarily meager 
array of facts furnished by this difficult and imperfectly 
worked out case. The interpretation which I offer is sub- 
stantially that of Freud and his eminent followers, with one 
important difference, namely, that in estimating internal 
mental conflicts I attach great importance to an intuitive 
recognition, which I believe to be bound up with the very 
nature of every mental act, of the contrast between the capac- 
ity of the mind for infinitely varied self-expression and the 
somewhat painfully felt inadequacy of each partial attempt 
at self-expression. 

The main symptoms from which this patient suffers 
may be briefly characterized as follows: 

1. An intense sense of unreality, which she refers to 
the universe, which she declares herself unable to make 
seem right. 

2. A horrible feeling of the "stoppage of air" coming 
on in attacks, not attended by real difficulty in getting breath, 
but giving rise to a sense of living death, or isolation from 
everything existent. If such an attack occurs when she is 
on the street she can hardly induce herself to take a farther 

277 



278 A Clinical Study of a Case of Phobia 

step, and is impelled to seek the nearest cover for protection. 
When asked what she fears under these circumstances she 
usually says, "convulsions," though her great underlying 
fear is of insanity. 

3. This desire for protection, which amounts to a 
craving, is very characteristic of her case, and dates back to 
early childhood. In her search for it she will frequently 
ring the bell of a friend's house, making some pretense of an 
errand that calls her there, and wait until she gathers 
courage to pursue her way.^ 

4. It seems to me doubtful whether one should attempt 
to draw a sharp line between this particular form of distress, 
or "Angst," that she describes as the "stoppage of air," and 
that may come over her at any time, day or night, and a 
kind of nightmare-like horror with which she sometimes 
awakes suddenly from sleep, and which is characterized by 
the necessity of struggling, as if for life, against some nameless 
and vague, but terrible and portentous influence that she 
refers mainly to her left side, sometimes dwelling especially 
on the left side of the head, sometimes on the left side of the 
body. Let me here say that her father first, later her mother,^ 
became hemiplegic on the left side a number of years before 
their death, and that the father suffered from left-sided 
convulsions. These parental illnesses, as I shall point out 
later, played an important part in the accentuation and 
modeling of her own. 

5. An overpowering dread of traveling alone and 
crossing streets alone (especially certain streets) and, indeed, 
an almost unconquerable dread of crossing any Rubicon, 
of making any decision. 

^ This strong desire for protection and sympathy showed itself in many ways, 
though it was often masked by her conspicuously frank and independent manner 
and speech. Thus, in the course of the discussion of Dr. Prince's and my papers, 
it came out that (in my opinion) as a part of her desire to feel herself in complete 
touch with the physician who was temporarily caring for her, she had said to each 
in turn, with unquestionable sincerity, that "now for the first time she began to 
understand her case," that "this treatment she believed in, while the others had 
been inadequate," etc., etc. In fact it is evident to me that it was the personality 
of the physician, not his wisdom, that made the deepest imprint upon her. 

^She is uncertain about the side of the mother's hemiplegia, but thinks it was 
the left. 



James J. Putnam, M.D. 279 

6. A fear of "parting," even from things of little 
worth, which is symbolized by her unwillingness to part with 
a letter by dropping it into the letter box, to part with a 
nickel by paying her fare to the car conductor. The analysis 
showed that at one period it was exceedingly distressing for 
her to part with her feces, at the toilet, and this may have a 
special significance, to which I shall call attention. 

7. These phobias are associated with compulsions and 
impulsions that oblige her, for example, to wear certain 
clothes, clothes that she had previously been wearing; to 
return once more to a house that she has just left, so that 
she sometimes occupies two hours in getting finally away; 
to pick up pins and papers; to carry amulets in her bag, 
against possible mischances. 

It is easy to see that in these compulsive tendencies 
the idea of taking precautions against possible harm to come,^ 
and of unwillingness to meet the possible dangers of change, 
are the prevailing motives, and that these characteristics 
connect symptoms here in question with the craving for pro- 
tection and the fear of change. It will appear later that 
these same motives have shown themselves at various 
critical periods throughout her life. 

The fact that this patient still remains uncured, or im- 
perfectly cured, makes the causes of her illness a fit subject 
for speculation; and since our present purpose is to compare 
and contrast explanations founded on far wider studies than 
the case itself would furnish the materials for making, a 
brief discussion of the reasons for the failure of all the many 
treatments that have been employed may serve a useful 
purpose. Whatever other causes may be assigned for this 
failure, it must be remembered that the patient herself is no 
longer young, and that no treatment is able to give her the 
outlet for her emotions which both her conscious and, still 
more, her unconscious nature have been craving. Sick she 
is protected, and leads an endurable, even though an un- 
satisfactory existence, made more tolerable by subconscious 
visions of greater happiness; well (that is, relieved of her 
worst symptoms), she would have to face a sort of struggle 

^ In part, these compulsions, like all others of their kind, may be classified as 
"ceremonials of propitiation and expiation." 



280 A Clinical Study of a Case of Phobia 

for which her temperament has unfitted her. She longs 
for some one to lean upon, for an assured income, for marriage, 
for congenial society and occupation, and for a home. Her 
symptoms illustrate these longings, while cold facts prevent 
their consummation. 

It is noteworthy that, a year ago, while I was studying 
her with some thoroughness, and while she herself was 
pleasantly occupied, she improved greatly, lost a large share 
of her symptoms, expressed great confidence in the psycho- 
analytic method,^ and up to a certain point seemed to com- 
prehend her situation from the psychoanalytic standpoint. 
Then came the necessity for actual tests of her power of 
standing alone, made necessary by the approach of summer, 
with its absences from home, and its separations from pro- 
tecting persons, and she rapidly backslid. An interesting 
dream of this period, which, with others, I obtained an 
opinion on from Dr. Freud and Dr. Jung, seemed to show 
a strong sense of leaning upon me for protection and affec- 
tion, as earlier dreams had shown still greater leanings 
towards others in a like relationship. 

The patient's personal and family history is, in general 
terms, as follows: 

She was born in a large city, where her grandfather and 
father were for many years successful and eventually 
wealthy merchants. This fact is of importance, because 
just about the time of the patient's birth the father lost 
his money, in consequence of an indiscreet investment 
which must be regarded as partly of neurotic origin, and the 
family life became one of struggle and sacrifice, diversified 
by recurrent hopes of better things, which arose only to end 
in disappointment. 

Several other members of the father's family had pre- 
sented neurotic traits to a marked degree, and had exhibited 
also — what is more important — special phobias which were ap- 
parently analogous to those from which our patient suffered. 

When the patient was a small child the father became 
involved in a public transaction which, although in no way 
dishonorable, brought him and his family into a notoriety 
which was at once unpleasant and exciting. 

iCf. footnote p. 279. 



James J. Putnam, M.D. 281 

In view of the facts accumulated through great numbers 
of psychoanalytic studies, it is fair to suspect, even though 
it cannot be entirely proved, that these various misfortunes 
to the father of our patient, and the fact that he did not 
react to them in an adequate manner, but became, as it were, 
benumbed, paralyzed, helpless, and apathetic, even before 
the onset of the actual hemiplegia (which occurred when the 
patient was two years old), had a serious effect on the mind 
of this sensitive child. She must, with her affectionate and 
dependent nature, have begun by adoring and leaning on 
him, at a time when he was substantially her only hetero- 
sexual companion; but she learned, through a long series of 
influences, of which a few have been just hinted at, to have a 
certain horror of him, and to look upon him as her evil 
genius, and yet as a personality with which her own had 
become strongly identified, as shown by her almost ever- 
present dread of his left-sided paralysis and convulsions, 
sinister in both senses. 

The other members of the patient's family consisted of 
the mother, who seems to have been in many ways a fine, 
though unpractical woman, and three sisters, one of whom 
was a half-sister, through a former marriage of the father. 
All of these sisters were in various ways neurotic. The 
oldest — the paternal half-sister — had and has marked 
phobias, and almost delusions of suspicion. The second 
sister, somewhat older than the patient, in several respects 
peculiar and dependent, used to sit alone, as a child, for 
hours, cross-legged on the floor of her room, with the door 
closed, crooning stories to herself, while she waved her hand- 
kerchief to and fro with a mysterious and stereotyped motion. 
If interrupted at this pastime she would get very angry. 

Finally, another person should be mentioned, who was 
virtually, though not technically, a member of the family, 
and an important one, namely, the nurse, to whose care 
the children were almost wholly delegated by the mother, 
whom a lack of practical instinct and preoccupation with 
the duties entailed by the stringent limitation of the family 
income rendered incapable of filling properly .the mother's 
place. This nurse, although devoted, and a woman of strong 
character and fixed purpose, was ignorant and superstitious, 



282 A Clinical Study of a Case of Phobia 

incapable of really understanding her charges, and sometimes 
unwise in her punishments and precautions, yet able to 
dominate the children by her strong will, and inclined to 
teach them stern lessons of repression, some of which were 
very unfortunate in their results. This nurse had the 
current fears about starting enterprises on Friday, passing 
under ladders, etc., etc., and kept alive as a rod of fear the be- 
lief that goblins lurked behind a certain door, who stood ready 
to spring out and capture the misbehaving and the disobedi- 
ent. The superstitions and fears thus inculcated easily took 
firm hold, though in a vague form, on the mind of the natu- 
rally gay, mischievous, and gentle but highly impressionable 
child, endowed with a fancy for and love of the mysterious, 
but not with a strength of intelligence and will capable of 
counteracting these emotions. 

In spite, then, of the fact that our patient's life was 
surrounded by many happy influences, it is certain that she 
grew up in an atmosphere charged with restriction, mystery, 
and fear, and with increasing feelings of criticism and sus- 
picion towards her father, with reference to whom, like every 
other child, she must have felt originally sentiments of 
affectionateness as object of her first heterosexual desires. 

I think it also of great importance that two distinct 
trends were present in her disposition as a child, and have 
been present ever since, which were antagonistic to each 
other and formed a part of the basis of her illness. On the 
one hand she was exceedingly gay, light-hearted, affectionate, 
trustful, inclined to assume the world simple and her con- 
ditions desirable, and inclined, also, within narrow limits, to 
be enterprising and a leader among her companions. On 
the other hand she was timid, superstitious, eminently de- 
pendent, and often unhappy; but these latter qualities were 
repressed in the interests of care-freeness and pleasure- 
seeking, and hence, in part, arose the conflict, which she 
would give voice to by saying at one time that her child- 
hood was happy, at another that it was unhappy. 

Her principal phobia as a child was with reference to 
death, and this became, even at a very early period, ex- 
ceedingly strong. She connected this fear with the death 
of this or that person among her relatives; but I believe, on 



James J. Putnam, M.D. 283 

evidence furnished by many other cases, its main root was a 
very deep one (having to do with vague ideas of the origin 
of life), and that so far as superficial roots were concerned, 
the principal one was a fear of the death of her mother, who, 
in consequence of the father's apathy and subsequent 
paralysis, became very early the mainstay of the family. 
Whatever other connotations it may have had — and I be- 
lieve there were several of importance — the death of her 
mother meant separation, parting, coming to an end, like that 
symbolized by the posting of her letters and the paying of 
her fares. This phobia of parting had two other roots, one 
symbolic, the other real. The former or symbolic parting 
was that involved in the movements of the bowels — the 
parting with the feces, i. e., with the most useless thing — 
and its meaning is perhaps made clearest if one draws a 
ratio, imagining her to say, "If parting even from this utterly 
worthless thing seems serious, then how much more other 
sorts of parting the possibility of which I dimly feel."^ 

The second fear of parting which seemed to me (and 
to her) significant was the parting from her own childhood. 
This was a prolonged and constant dread; and if her child- 
hood itself, as now remembered, was partly happy, it was 
partly also very unhappy, and this very unhappiness became 
an element of intensification of the distress of the idea of 
parting — important because illogical. The old dictum of 
Thomas Aquinas, ^^ Credo quia impossibile,^^ which has so 
often been derided by persons who did not grasp its psycho- 
logical significance, is applicable here. That which we 
cannot justify ourselves for feeling strongly about, but which 
nevertheless we do feel strongly about, has a peculiar in- 
fluence on us which only a deep-going analysis can explain. 

This fear of parting from her childhood was further 
strengthened, some years later, by an influence drawn from 
her strong maternal complex. It is, namely, highly probable 
that just as her fear of parting with the feces doubtless con- 
nected itself with other elements of an anal complex, so the 
additional fear of what would happen to them when her 
mother should die must have woven itself into her death- 
fear-complex, and into her superstitious dread and love of 

U say nothing of the possibility of an infantile rectal birth-fantasy. 



284 A Clinical Study of a Case of Phobia 

mystery in every form, as indicated by her love of fairy 
stones and her dread of the malicious goblin behind the 
entry door. 

But, I repeat, these dreads, and many more, were largely 
repressed in the interest of her love of gayety and of light- 
heartedness. 

When the patient was about ten years old these fears 
became complicated with another which is of peculiar sig- 
nificance, and which, although it passed away after a year or 
so, formed one element in an unbroken chain or network of 
phobias that stretches from her infancy to the present day. 
This was a fear that she should get up in the night and, 
without realizing it, should swallow pins. The interpreta- 
tion of this fear as a coitus-fear, at least in part, which is 
of so well recognized a sort that it has received the name of 
"Spitzenfurcht," becomes clearer through a consideration 
of other facts. 

In the first place, she had already been in the stage of 
sexual curiosity, and had asked her mother with reference to 
certain statements which another girl had made to her. Her 
mother did not treat her curiosity with contempt, but gave 
her very little information. She thinks that this little 
satisfied her, just as she thinks that the whole subject of 
the sexual life had very little interest for her, — a belief with 
regard to herself in which it became clear later that she was 
wrong, as she was with regard to the belief which she at first 
entertained that her childhood was uninterruptedly happy. 

The significance of the "Spitzenfurcht" as a sexual 
symbol is further brought out by the fact that she well re- 
members herself and her sister being chased, on more than 
one occasion, by a dirty-minded boy of their acquaintance, 
who ran after them, with his genitals exposed, partly trying, 
partly threatening to try to pass water over them, an ex- 
perience which must, in my judgment, have been strongly 
intensified, a number of years later, by a sudden apparition 
of an exhibitionist, who exposed himself before her on a lonely 
hillside. This latter experience had, of course, no relation 
to the "Spitzenfurcht" of her early youth, but both sets of 
events worked together, as I believe, toward the formation 
of her later fears. Certain pranks that she played with her 



James /. Putnam, M.D, 285 

sisters, in which the passing of urine figured as a sport, should 
also be mentioned in this connection. 

It is of further interest to note that at this same period 
of childhood the patient suffered greatly through several suc- 
cessive years, especially in the springtime, from pinworms, 
a form of irritation which she learned greatly to dread, the 
more so that the stern disciplinary methods of her nurse 
kept her, to some extent, from getting the relief which might 
have been afforded her, though in the end she usually had 
rectal injections, which did much good. 

The fear of the pin-swallowing followed immediately 
on the pinworm period; but whether it was due to it, or 
whether the rectal irritation was communicated to the 
vagina, and then, by links of association such as have been 
clearly made out for other cases, a mysterious and vague, 
but strong emotional grouping of the two sets of experiences 
occurred, I cannot positively say. My surmises are affirma- 
tory, and those who have become familiar with the educa- 
tional effectiveness of the child's fancy, those who have 
learned to know to what an extent a child builds his unseen 
world of materials which are absolutely discarded at a later 
period, will admit the value of the inference. 

I would say also that I have rarely, if ever, seen a 
patient who was so successful as this one in cloaking from 
herself the rich and abundant subconscious fancies of her 
now repressed life, under the peculiarly effective disguise of 
an apparently complete frankness. The comprehension 
of this fact, which, of course, accounts largely for her con- 
tinued illness, is so important to the theory of her symptoms 
that I will anticipate the later portion of the story to the 
extent of referring to two dreams of many years afterwards. 

This was one of the so-called "insufficiently dressed" 
dreams which in one or another form are so extremely com- 
mon. It may be that the lapse from propriety consists only 
in the absence of a collar or a tie; or it maybe that thedreamer 
finds himself in a ball-room attired in a nightdress. The 
meaning is, up to a certain point, the same; that is, the 
dream represents a reversion to the pleasures of one's nursery 
days, when running about with insufficient clothing was in 
order, and at the same time a hint that those pleasures, in- 



286 A Clinical Study of a Case of Phobia 

nocent as they were, depended partly for their charm on 
exhibiting one's self and gazing curiously at others. In 
other words, such dreams show, what we ought in the in- 
terests of human sympathy to recognize, that between our- 
selves and those whom we stigmatize as "exhibitionists," 
and, therefore, criminals, the difference, important as it is, 
is one of degree alone. 

Sometimes these "insufficiently dressed" dreams go 
much beyond a simple hinting at the nursery period of 
childhood, and give evidence of the existence of emotions 
and feelings on the dreamer's part, which, although still 
unconscious, demonstrate the presence of real exhibitional 
instincts of a well-marked type. 

Such was the case with this patient, in spite of the fact 
that in her self-deceiving frankness she denied, at first, all 
interest in such matters. She dreamed, in brief, that she, 
then a woman grown, was taking a bath in a public street, 
in a tub which was placed not only in the view of all be- 
holders, but, suggestively enough, in the gutter of the street. 
I talked this dream over with Professor Freud, and he asserted 
confidently that it could have but one meaning, namely, 
that the patient's unconscious, repressed sexual cravings 
were so strong that she was, as it were, whispering to herself 
that she would go any length to gratify them. In other 
words, this dream was a so-called prostitute-dream. I could 
mention several of her dreams, of like character, but this ex- 
ample may suffice to indicate how widely the unconscious 
portion of her life differed from the conscious portion, and 
to justify us in inferring the same origin for her symptoms 
with that which the accumulation of evidence has made 
probable for all such symptoms as she presents. 

It will have become obvious that the thesis which I am 
defending is that the fears from which this patient suffered 
in her childhood (of which the fear of death, the fear of pin- 
swallowing, the fear represented by her superstitious dread 
of the goblins, and the fear of parting with her youth were 
samples), and also the many distresses with reference to her 
father, who was bound to her by the ties of a first love, were 
essentially fears of herself, fears of her own emotions — felt, 
but misunderstood and repressed — which already made it 



James J. Putnam, M.D. 287 

vaguely evident to her that she was in the grip of a set of 
strong tendencies of thought and action, the origin of which 
was beyond her ken. 

I have intended, furthermore, to make it clear that, in 
my opinion, these tendencies were really based on the stirring 
within her of her sexual nature, which I believe to be and 
to have been, not slightly developed, as she at first thought, 
but strongly developed, as indicated by the dream alluded to. 
I believe also that all her fears have, in general terms, a 
common partial basis, and are interwoven with one another. 
It is now well known to those who have studied into such 
symptoms from this standpoint, that one of the causes of the 
fear of going about alone, from which this patient suffers, 
is typified by the conscious fear of a person exposing himself 
to a temptation — say a drunkard — namely, a fear of 
yielding. This is closely related to a morbid tendency to 
cling for protection to one's nest, one's home, to familiar sur- 
roundings, — in a last analysis, to one's mother. "How shall 
I reach my decisions alone .^ How shall I arrive alone at the 
hardest of decisions, that, namely, which implies the re- 
sisting of strong temptations, temptations not manifest and 
acknowledged, but felt only as emotional distress?" But 
temptations are imposed really by ourselves, and the dream 
referred to hints at the general character of some of these. 

I have no desire to deny any well-grounded evidence 
that there may be other causes of morbid fear than those 
which I have mentioned. Fear may be primitive and 
natural; it may point back even to ante-human ancestral 
experiences. I would only emphasize the necessity of great 
caution in asserting the "primitive" nature, even of in- 
stincts, and would call attention to the fact that just as a 
chicken has, after all, to learn to peck for food,^ so each 
child, in one sense, may have to learn through experience 
to fear, and learns this largely through grappling with re- 
pressed emotions of desire, which is, I believe, to be under- 
stood as corresponding to a vital impulse of expansion, more 
fundamental than fear, though ready to express itself as fear. 

^I refer to certain experiments indicating that chickens, if carefully fed from 
the very outset, do not necessarily peck; in other words, that even instincts are 
in a sense acquired. 



288 A Clinical Study of a Case of Phobia 

One other, seemingly trivial, experience of her early 
childhood may also be referred to, because it bears out this 
view and helps to illustrate the important contrast between 
this patient's repressed inner life and her ostensibly unified 
outward life, which the inner life was systematically de- 
ceiving by a sort of elaborate confidence game. Among a 
number of obnoxious regulations imposed upon her by her 
devoted but unpractical mother and her stern, repressive 
nurse, one of the most obnoxious was that of wearing certain 
rough, heavy woolen underclothes which she detested, and 
found hot and uncomfortable. Her objection to these gar- 
ments, which at first seemed of this purely superficial sort, 
was, however, a*s I found on close inquiry, based on some- 
thing more than the reasons given. It amounted to a horror, 
and the admission was finally made that this was due partly 
to the fact that they gave rise to sexual irritation, of a vague 
sort. In other words they excited a species of masturbatory 
craving which was too strong to be agreeable. 

I have dwelt on these half-forgotten incidents of child- 
hood because of their value as at once illustrating the nature 
of the forces that were at work, and as accentuating on 
specific lines the action of these forces. 

The remainder of the history, although more dramatic, 
can be passed over much more rapidly. What may be called 
her second period, that of pre-adolescence, was passed 
quietly in Europe, with congenial studies and simple socia- 
bility, and with more or less of admiration, which she loved. 
The principal drawbacks were a long illness of the father, 
who had become paralytic on the left side and was a great 
care, and the strain on the mother which this and their 
relative poverty involved, and finally the anxiety lest the 
mother's health would fail. During this period she suffered 
from a prolonged diarrhoea, for which I suggest an emotional 
origin. 

The first "train-fear" occurred at the time of parting 
from this pleasant life, made necessary by the mother's 
illness, — a parting like that from her first childhood. 

The third period was a very significant and important 
one. Social life was over, but not the longing for its repeti- 
tion, and the deeper cravings underlying this longing. A 



James J. Putnam, M.D. 289 

limited income made it necessary for them to accept the 
chance of occupying a house on a relatively remote hilltop, 
just near enough to the city to enable them to see oppor- 
tunities of which they could not take advantage. The 
father's hemiplegia had become complicated by the epileptic 
seizures, involving mainly the left side, and these the patient 
witnessed, and dreaded for herself, the more so for seeing in 
herself her father's child, and in him one of the first objects 
of her intense subconscious love; later, of antipathy and 
scorn. For seven years he slowly moved towards the final 
parting of death, and his death was longed for by his family 
as the only solution possible. 

This situation, in which the dread induced by her 
father's long-standing paralysis and recurrent convulsions, 
and the vision of his slowly approaching death (which at 
the very last came so slowly that he seemed for days alive 
in death) was mingled with her own longing for freedom and 
a wider life, was intensified during this same period by two 
similar events. 

In the first place, two paternal aunts who had lived 
with them, and towards whom the patient had entertained 
feelings of very mixed sorts, likewise died very lingering and 
distressing deaths; and much the same was true of the 
mother, who had finally become paralyzed like the father. 

With the death of all these relatives, what might be 
called a third period opened for our patient. She and her 
sister were now somewhat more free to follow their inclina- 
tions, and somewhat better off financially, though still a 
little pinched. Psychologically, however, the situation did 
not improve, but, on the contrary, tended to grow worse. 
The patient had never been a mentally unified person. She 
did not know herself, but was torn by cravings which she 
could not understand, and every new opportunity or re- 
sponsibility only accentuated the breach between the con- 
scious and the unconscious portions of her life. The 
phobias, which from now on gradually increased, and the 
compulsions which became associated with them, sym- 
bolized the conflict between her craving — some elements 
of which had been long and carefully repressed — for pro- 
tection, for marriage, for a home, for social success, and for 



290 A Clinical Study of a Case of Phobia 

social intercourse suited to her kindly and peace-loving 
disposition, and the necessity of adjusting herself to quite 
a different state of things. She felt herself moving towards 
an age when marriage would be impossible, and yet her 
dreams demonstrated clearly that marriage was biologically, 
as well as socially, a strong need. She saw herself parting 
from her adolescence and early middle life as she had parted 
from her childhood. 

The images of life which many painful experiences, 
here only hinted at, had raised before her, as if in mockery 
of her imagined pleasures and activities, were those of dis- 
appointment, passivity, renunciation, and slow death, affect- 
ing primarily her father, with whom she, psychologically, 
was identified. She had not the moral and mental force 
(which is little to be wondered at) to make for herself a new 
world suited to her best and real powers, and went on making 
unconscious, cramp-like attempts to substitute a world of 
fancy for a world of reality. 

Her dependence, illustrated later by remarkably intense 
unconscious and instinctive grasping for the protection and 
affection for her physicians, had its root in early parental 
fixations, and was fostered by the necessity of helpless 
struggling against many and various adversities. 

All these conflicts were typified in her dream-like 
phobias and compulsions. The streets that she longed to 
cross, but could not; the papers and pins which she accumu- 
lated; the failure of air which overwhelmed her; her inability 
to travel by herself; her fear of parting even with a letter 
or a fare, — all serve as so many pictures of longings and crav- 
ings, of a shrinking from instincts too strong to be assimilated, 
of the dread of the future foreshadowed in her father's life. 
The left-sidedness of her nightmare terrors symbolizes, in 
probability, not alone her memory of her father's hemi- 
plegia and the convulsions which she so dreaded to wit- 
ness, but also the sinister tendency of her own fancy of 
evil. 

Certain of her most striking symptoms were ushered 
in, about eight years ago, by a prolonged attack of jaundice. 
It is easy to assert that this was the cause of nervous symp- 
toms, but my observation in a number of striking cases leads 



James J. Putnam, M.D. 291 

me to believe that it is of less importance as a cause than as 
a result of these conditions. 

There is one point to which I have referred in the above 
remarks which I think cannot too strongly be accentuated, 
namely, that in my view, however primitive the emotion 
of fear may seem, it is, nevertheless, probably secondary to 
desire; and if we assume, as I positively do, that evolution, 
whether of the individual or of the race, depends upon the 
tension of a vital impulse, it is obvious that this tension is, 
in general terms, making for progress. If we express it in 
the terms of consciousness, it is equivalent to desire.^ Of 
course, as every one knows who has studied the gradual 
formation of any given fear, the secondary element of dis- 
tress comes more and more into the foreground as time goes 
on, while the element of desire is liable to recede into the 
background. 

A case illustrative of these points, in a form previously 
somewhat new to me, has very recently come to my at- 
tention. 

A lady who in her youth suffered terribly from com- 
pulsions of certain sorts — related to so-called over-con- 
scientiousness — used to fear continually that some harm 
would come to her mother, and used to ask her mother 
twenty times a day if she thought she would live until the 
morrow, and to follow her in the street with the same 
anxiety. The asking of these questions was a delicious 
torment to herself, and an unmitigated torment to her 
mother. For some time the patient was unable to recognize 
the fact that this torment on her part could be expressible in 
terms of wish. After a while, however, she said that she 
well remembered an older friend saying to her on one of 
these occasions, "I verily believe that it would be a great 
relief to you if you could know that your mother had died." 
This she herself admitted, and then on further thinking of 
the matter it became apparent that what really was at 
stake, and had been at stake since the beginning, was her 
own inward tension, expressible in terms of a craving with 
relation to her mother, which could not find sufficiently 
strong expression except in some terms that should picture 

^ Or the two may have polar relationship, as Dr. Van Teslaar has suggested. 



292 A Clinical Study of a Case of Phobia 

her mother in a condition of suffering. This intense craving 
was obviously at first pleasurable, if one grasps the full 
meaning of the word "pleasure"; but it became gradually 
an intense pain. 

The patient herself furnished several other instances 
illustrating the same principle. Thus, looking at a work- 
man on the upper part of a building opposite to where we 
stood, she said that she was aware of a painful tension lest 
he should fall, and added that if he should fall the relief of 
that tension would bring her a certain satisfaction, a satis- 
faction in which, obviously, the workman himself could hardly 
share. 

In brief, then, I believe that this case is one of mixed 
psychoneurotic tendencies which is best explained in accord- 
ance with the doctrines first clearly enunciated by Sigmund 
Freud, taken in conjunction with certain philosophic rea- 
sonings which I believe to accompany instinctively every 
mental act. So far as the former doctrines are concerned, I 
believe that she acquired in early childhood certain longings 
or cravings, misunderstood and soon repressed, which re- 
flected a number of autoerotic sensations, classifiable in 
general terms as sexual or erotic, and leanings towards her 
parents, for which the same classification is applicable. In 
the fears and attempts at adaptation of her later life, these 
deep, . unsatisfied, and unconscious cravings formed an 
element too strong to be overlooked or mastered, yet never 
thoroughly assimilated. She "feared" her own misunder- 
stood desires, inherited from infancy, and adopted imperfect 
means of compensation for the internal conflicts to which 
these fears gave rise. 

The inner cravings, rooted in infancy, which make 
some persons criminals or perverts, made her an invalid. 



PROCEEDINGS OF THE AMERICAN PSYCHO- 
PATHOLOGICAL ASSOCIATION, MAY 29, 1912 

The third annual meeting was called to order by the 
President, Dr. Adolf Meyer of Baltimore, Md., at the State 
Psychopathic Hospital, Boston. 

Dr. Adolf Meyer delivered the Presidential Address.^ 

Dr. Morton Prince presented a paper entitled "The 
Meaning of Ideas as Determined by Unconscious Settings." 

Dr. James J. Putnam and Dr. Morton Prince contrib- 
uted a symposium on "A Clinical Study of a Case of 
Phobia." 2 

The last three papers were the subjectof the discussion. 



DISCUSSION 

DR. E. W. TAYLOR, Boston: I am glad to say a few 
words about this patient, particularly since her 
history is known by various physicians who are 
present. She has consulted a number of neurol- 
ogists in Boston, and in each instance has followed out the 
treatment prescribed with great faithfulness. She is an 
unusually open-minded woman, not so defensive in my 
judgment as Dr. Putnam seems inclined to assume. She 
spoke with great candor and always with loyalty of the 
various doctors with whom she had had dealings. She 
appreciated their efforts in her behalf, and also their failures, 
and in general was keen in her analysis of methods. From 
this standpoint, therefore, her impressions were interesting 
and of value. 

I may say at the outset, without implying the slightest 
disparagement of the methods used, that the so-called psycho- 
analytic method as practised by the followers of Freud did 
not appeal to her. That does not prove in the slightest 
degree that the method might not have led to improvement 
or actual cure, but the fact remains that Dr. Putnam's 

^ To be published in the next number of the Journal. 
' Printed in this number. 

293 



294 The Journal of Abnormal Psychology 

analysis, in which she tried her utmost to co-operate, did 
not lead to improvement of the fundamental disturbances. 
It is, of course, altogether possible that she could not be 
reached through psychoanalysis, and again I repeat that the 
failure should not be regarded as a disparagement of the 
method. The fact is stated simply as an interesting point 
in this discussion. I cannot now go into what she said of 
other methods. She was apparently benefited in some 
degree by all to whom she went, and found in each man's 
method something of practical value. When Dr. Prince 
states that she derived more benefit from the Emmanuel 
treatment than from any other, he perhaps does not state 
the fact exactly in its proper light. It was rather the em- 
ployment which she had while undergoing this treatment 
than the psychological elements in the treatment itself 
from which she derived benefit. 

Without entering too much into detail, she appeared to 
be one of that large class suffering from the fundamental 
inherent fears, which I believe we all have. I refer to the 
instinct of self-preservation, which otherwise expressed 
means the fear of death and secondarily the fear of insanity, 
as Sidis among others has pointed out. In my judgment, 
every one, when he reaches self-consciousness, has an in- 
herent fear of mental alienation, secondary only to the 
natural instinct of self-preservation. In this patient both 
of these factors came out very distinctly. 

My method with her was, and she was good enough to 
say it was beneficial, simply a painstaking elucidation of the 
significance of these attacks and of their bearing upon the 
peculiar fears which she had developed. I did not go into 
the aspects of the case that Dr. Putnam has developed, 
because I knew that had been thoroughly done. The in- 
vestigation of the nature of her fears, especially the extraor- 
dinary one of the unreality of air, I went into with extreme 
care, without using hypnosis, with the general result that 
she was able to take a more rational view of her condition, 
and to lead a distinctly more normal life. That of course 
must be regarded merely as the first step in the mental cure. 
The second, and in many ways the more important, is the 
application of such theoretical considerations to her actual 



Proceedings 295 

life. This was brought about by an insistence on employ- 
ment and activity, which with some backsliding she has 
faithfully prosecuted. The general result was that she was 
able to discard many of her fears, although she showed a 
strong tendency to develop others. It seemed to me dis- 
tinctly that it was not necessary and not profitable to apply 
the sex idea. I am quite willing to be convinced if I am 
wrong, but my present conviction is that more could be 
gained in this case by an appeal to other elements in the 
situation, and this in my judgment was borne out by her 
progress toward improvement. 

Dr. James J. Putnam called attention to the fact that 
Dr. Prince, in his paper, referred more than once to the 
patient as saying, "Now I understand. I never thought 
of that before." Dr. Putnam said that in speaking to him 
the patient had used the same phrase a great many times. 
Referring to the psychoanalytic method, the patient re- 
peatedly said, "I never before had any treatment which 
really made me understand myself and the nature of my 
trouble as this does." 

Dr. Putnam said that he called attention to this point 
for no other reason than to illustrate the fact that the 
patient's frank manner, which she distinctly encouraged in 
herself, formed a sort of defence symptom. It is partly 
because she is so ready to adopt the view and attitude of 
the physician who is treating her that she deceives herself. 
Dr. Putnam said that during the spring, at the end of which 
she ceased her attendance with him, she appeared to be in 
many ways almost well, and many of her fears seemed to 
have disappeared. She was working and happy, and going 
about freely. Then came the prospect of the summer, when 
he was to go away, and she was to go away, and this brought 
out with intensity her need for protection, and induced a 
relapse of symptoms. In view of these facts, the judgment 
expressed by her to Dr. Taylor, that the psychoanalytic 
method had not helped her, should not be taken as of much 
importance. 

Dr. E. W. Taylor, Boston: What Dr. Putnam has 
said is interesting in this connection, and I should say that 
the patient was glad to admit that her character had been 



296 The Journal of Abnormal Psychology 

improved through an application of Freudian principles. 
Apparently she has made different statements to the various 
physicians who have treated her. 

Dr. Isador H. Coriat, Boston: This patient was under 
my care for about a year, and I saw her frequently during 
that period, several times a week. When she first came to 
me the neurosis consisted principally of a fear of open and 
closed places, impulses to collect useless objects and a fear 
of losing her mind or fainting in public places where she 
would be seen. At first she did not dare to go around alone 
without a member of her family and a nurse accompanying 
her. The analysis of Dr. Prince in the light of what I 
know of the patient seemed to me to be perfectly applicable. 
While there may have been childhood conflicts which may 
have led up to and caused the psychoneurosis, I feel that 
the real starting point of her fears and unrealities was later 
than in childhood. My treatment with her consisted prin- 
cipally of re-education, of daily routine, and later of hypnosis 
in order to bring about, as Dr. Prince has stated, a new psy- 
chological setting. I tried to substitute for the fears and 
unrealities a feeling of self-reliance, of confidence, and to 
establish the realities of things about her. 

Dr. B. Onuf, New York: I think this is an extremely 
suggestive and interesting subject which has been presented 
in an extremely suggestive manner, and having had one case 
that had many similar features, I beg leave to say a few 
words on the mechanisms observed in it. I suppose if more 
cases were studied they would all be shown to have many 
features in common. One thing that struck me in my case 
was the extreme systematization of the ideas which I see 
was also present in the case of Dr. Prince and Dr. Putnam. 
This systematization is so marked that it has a great deal 
of similarity with the systematization of a paranoiac. The 
question is, what gives this systematization? I think it is 
simply this, that all these ideas as they develop from each 
other have some element in common, an emotional element, 
namely, a feeling of wrongdoing, a feeling, however, that 
the patient is not conscious of, denying its existence strenu- 
ously. In my case there were some very remarkable 
features, such as this absolute denial of things that seemed 



Proceedings 297 

to be absolutely apparent on the surface. It seemed to me 
that the denial of the wrongfulness of her conduct allowed 
the patient to persist in it, but gave rise to obsessing fears 
and compulsive actions taking the place of the conscious 
wrong feeling. In this case a history of masturbation was 
present, which dated back to childhood, and the patient per- 
sistently refused to believe that when she masturbated she 
did anything wrong, and I demonstrated to her that in her 
actions she gave proof of being aware somehow that in 
masturbating she did something not approved of, because 
she maintained the greatest secrecy in the performance of 
the act, and I think that this very fact proved her being 
in some way aware of the wrongfulness of it. The very 
interesting fact was revealed that she practised the act at 
night while in her bed, which she was always sharing with 
her sister. Yet her sister knew nothing about it. She 
must, therefore, have used extreme precautions to keep the 
knowledge of her masturbation from this sister. One of 
patient's obsessions was a fear of light, and she had this fear 
at night, but only after she had retired to bed. This I ex- 
plained on the basis that she was, without acknowledging it 
to herself, extremely afraid of the light because of the dis- 
covery of the act of masturbation which the unexpected 
appearance of the light might bring on at any moment. 

Dr. James J. Putnam, Boston: I considered the possi- 
bility of hidden masturbation because I thought that also 
important. I did not speak of it at length because I wanted 
to avoid taking time. There was, however, evidence not 
indeed of that habit, but of kindred tendencies. 

Dr. Brill, New York: In the time at our disposal it 
would be impossible to make an effort to interpret the facts 
given. I was pleased with the interpretations given by 
Drs. Prince and Putnam and was very interested in the 
remarks made by Drs. Taylor and Coriat. However, the 
question to be answered is why the patient is not cured. 
From the facts presented we deal with an unmarried woman, 
and in my experience such patients are very difficult to 
manage. The trouble lies in the unrequited libido. We 
know from our psychoanalytic work that the symptoms are 
substitutive gratifications of a repressed sexuality, and to 



298 The Journal of Abnormal Psychology 

cure such patients they must get some psychic or physical sub- 
stitute, e. g., " sublimation." Moreover, those who know the 
mechanim of transference will understand why the patient felt 
well while she was under the care of the different phsyicians, 
and why she relapsed as soon as she was left to herself. That 
would also account for the contradictory statements she made 
to Drs. Putnam and Taylor. Considering the case from this 
viewpoint, we can also understand why she is feeling better 
now. Her work affords her some sublimation. 

Dr. Emerson, Boston : It may be well that for a moment 
we should forget the concrete woman. I personally do not 
know her, never heard of her before. Although Dr. Prince 
said his facts were different, I fail to see any difference. He 
had seen exactly the same facts. The only difference one 
could speak of is concerning the presentation of the facts. 
Dr. Prince has given us a photographic description of the 
case. Dr. Putnam presented th^em more concretely. Then 
the question is, what brought about these facts? The 
difference between Dr. Putnam and Dr. Prince is a differ- 
ence of causation. It is like attempting to explain the 
movements of a steam engine by describing the movements 
of the piston rod which makes the wheels move and that 
makes other wheels move. From my point of view that 
would be no explanation of the cause of the moving of 
the car. Dr. Putnam took us to a deeper level, the level of 
instinctive impulses. The discussion centers around the 
same facts, but the explanation of these facts is different. 
I do not see any necessary conflict at all. 

Dr. L. Pierce Clark, New York City: I, too, agree 
with Dr. Brill that all the explanations and analyses in this 
case are along the right line. Dr. Prince's explanation is 
what one might call the obvious content of the anxiety state, 
but Dr. Putnam has gone deeper into the sexual constitution 
and its make-up; his analysis is therefore more preferable. 
It may be possible for us in the near future to understand the 
heredity laws in such a way that we can indicate what psychic 
traits are composing the sexual or neuropathic constitution. 
It may be therapeutically nihilistic for us to know this, but it 
will certainly clarify our understanding of the derivation 
soil of the frankly established psychoneuroses. 



Proceedings 299 

Dr. Ernest Jones, Toronto: In my opinion such a 
symposium as this would be much more fruitful if the subject 
matter could be narrowed to a few definite points instead of, 
as here, being extended over the whole field of the neuroses 
and of psychotherapeutics. As I urged in the discussion 
last year, the most advantageous way of approaching the 
problem of the anxiety states is to take the simpler forms first, 
those characterized by predominantly somatic disturbances. 
The present case, on the contrary, is clearly one of a mixed 
neurosis, a mixture of anxiety hysteria, anxiety neurosis, 
and obsessional neurosis. 

In regard to the main symptom in the case under dis- 
cussion, the fear of insanity and death, we all seem agreed 
that the explanation of it given by Dr. Prince is correct 
so far as it goes, but many of us think that it is incomplete. 
Roughly put, it is that the prominence of this fear is due to 
certain mental experiences in reference to it that the patient 
had gone through earlier in life. These experiences were 
almost normal ones, they are at all events very frequent and 
banal, and Dr. Taylor goes so far as to say that the fear 
itself is a normal one. Why then does the patient suffer .^^ 
It is surely obvious that there is here no adequate answer to 
this plain question. Psychoanalytic experience, on the 
other hand, provides an adequate explanation of the suffer- 
ing. It shows that the ideas in question are connected with 
and symbolize other deeper ideas and unsatisfied cravings, 
the infiuence of which the patient has every right to fear. 
The intensity of the morbid fear is entirely justified, but the 
affect has been displaced from its true source on to an asso- 
ciated one, the origin of it being thus concealed. 

Dr. Tom A. Williams, Washington, D. C. : In regard 
to the explanation of the fear of air, it was obvious, and I 
am surprised that no one mentioned it (that is by the Freud- 
ian process), that she desires something that is signified by 
air. In regard to her phobias, there are two: one type 
which is merely induced, which may or may not have been 
induced in this case by peculiar complexes, and the other, 
the fear of herself, which is common among women. These 
are two distinct forms of fear reaction which may be induced 
far back in childhood. 



300 The Journal of Abnormal Psychology 

Dr. Adolf Meyer, Baltimore, Md.: I am decidedly 
gratified by the course of this discussion. It is bound to 
bring out different manners of picturing and understanding 
cases excelling either in the direction of accuracy of detail, 
in what Dr. Emerson calls the mere photographic description, 
or in the direction of analysis, which gets more at the funda- 
mental things with which we must learn to cope if we want 
to obtain useful conceptions of orthobiosis. 

Dr. Morton Prince, Boston: First as to what Dr. 
Taylor has said regarding the fear of insanity being universal. 
I would not be willing to accept this statement in a sense 
that is germane to the question at issue. Even if there is a 
universal aversion to insanity, which is all that can be meant 
by it, this is not a fear that a person will he insane. The point 
is whether a fear of becoming insane had entered through 
various experiences of life into a complex, had become 
so constellated with these experiences that they determined 
her perception of herself as an insane person. I think 
that is fundamental to my conception of this sort of a case. 

Dr. Brill says that "we know" the main difficulty in 
phobia is ungratified libido. That is only a priori reasoning 
and begging the question. It is one of the questions at 
issue. From the data elicited in this particular case I 
maintain there is no evidence for it and we do not "know" it. 
The object of this symposium is to deal with the evidence 
offered by a concrete case. If any facts had been brought 
out to show ungratified libido as a causal factor, we could 
accept the theory. Otherwise this is a priori reasoning 
applied to particular case; to this I take exception. There 
have not been any facts brought out here to show such a 
fundamental cause. I have failed to find them. I may be 
wrong, but as I have elicited and studied the facts in this 
case and as Dr. Putnam has given them from his point of 
view, I have failed to see any evidence for such a conclusion. 
Nor do I find that my experience agrees with that of Dr. 
Brill when he states that unmarried women are more diffi- 
cult to cure. I do not find it so. At this moment I find no 
difficulty in recalling a number of unmarried women who 
were cured without any greater difficulty than were the 
married women. 



Proceedings 301 

Dr. Emerson said that he could not see any difference 
between the facts elicited by Dr. Putnam and those by me. 
It seems to me that there is a marked difference. A fact I 
brought out, one of primary importance, was the real object 
of the patient's phobia, namely, insanity and not the feeling 
of unreality assumed by Dr. Putnam, It is essential when 
attacking a problem of this kind that we should understand 
what the real object of the fear is. How can we determine 
the psychogenesis of a phobia unless we first determine 
the object of the phobia.^ Of course, if we start with the 
a priori principle that the fundamental factor is libido, why 
then, I suppose, the exact object of fear is of secondary 
importance. 

If the object of the idea is insanity or death we want to 
know the setting that gives the meaning to l^e idea. I 
think also it is a different set of facts that I present when I go 
back to a series of experiences which form the settings and 
give the meanings to her ideas of death and insanity. Per- 
haps they are not necessary facts, but that they are a differ- 
ent set of facts from those of Dr. Putnam seems to me an 
obvious proposition. 

Now a word as to my conception of the unconscious. 
I conceive the unconscious not as a wild, unbridled, con- 
scienceless subconscious mind, as do some Freudians, ready 
to take advantage of an unguarded moment to strike down, 
to drown, to kill, after the manner of an evil genii, but as a 
great mental mechanism which takes part in an orderly, 
logical way in all the processes of daily life, but which, under 
certain conditions involving particularly the emotion-in- 
stincts, becomes disordered or perverted. We think that 
in everyday life we consciously do the whole of our thinking; 
but I am inclined to think that our unconscious self does 
most of our thinking, and that we simply select from the 
ideas furnished by the unconscious those which we believe 
are best adapted to the situation; that our problems are 
much more solved by the unconscious than by the con- 
scious. I regard the normal unconscious as a logical, 
orderly mind, playing an important part in everyday life. 
Therefore, as I see it, this conception of unconscious ideas 
is fundamental, and not the libido, although the instincts 



302 The Journal of Abnormal Psychology 

play a tremendous role in carrying, by the force of their 
conative impulses, ideas to fruition and setting up conflicts 
between opposing ideas with resulting disharmony. 

Dr. James J. Putnam, Boston: It is very plain to me 
that the real discussion to-day, although it is supposed to 
hinge particularly on the facts presented by this patient, 
must in reality take into account, both on Dr. Prince's 
part and mine, a number of pieces of evidence and general 
conclusions derived from numerous other cases observed and 
studied by ourselves and described by others. If one was 
obliged to rely upon the evidences of this case alone, it 
might be very slight and inconclusive. This is particularly 
true as regards the symptoms observed during the patient's 
childhood, which I should classify as "sex" symptoms, 
assuming that word to be understood in the proper sense, 
and leaving out of consideration for the moment certain philo- 
sophic presuppositions which I believe to be present in every 
person's mind. 

The patient considered herself originally as free from 
any particular sex feelings, and made that impression, I 
think, on most of her physicians. The point is that she did 
not, and could not, take into consideration the repressed 
elements in the longings and cravings and fears which she has 
had to deal with in abundance. 

. The other kinds and pieces of evidence to which I have 
alluded, if I could present them here, would show clearly, I 
believe, that if these repressed elements could be revealed 
in their full intensity, what I say would prove to be correct. 
The very striking dream to which I have referred, and others 
of like character, should be taken as an indication of this 
sort, and this meaning should be attached, at least in part, 
to her early idea of death, then to her fear of swallowing pins, 
to her fear of parting from her childhood, parting from her 
mother, parting from letters, and parting even from her excre- 
tions. 

One great difficulty in treatment is that the patient 
longed for protection and a home, which should reproduce 
in the best sense the home and protection of her childhood. 
But these benefits we cannot give her, and so she strives 
after a substitute for them, by leaning first on this person. 



w 



Proceedings 303 

now on that, and by unconsciously cultivating a series of 
phobias in which her longings are negatively represented. 

Dr. Adolf Meyer, Baltimore, Md.: It goes without 
saying that we have been confronted with the fact that two 
perfectly honest observers can come forward, one with the 
statement that there is no libido in the case, and another 
bringing a mass of material to the front which I think we 
can safely leave to the audience to pass on. It ought to be 
perfectly plain that there are various levels and directions of 
penetration and special advantages to be derived from 
them for practical purposes. Whether one takes the under- 
currents or goes specifically into the details which lie on the 
surface, the net result after all depends on a correct biological 
understanding of the facts. 

Dr. Morton Prince, Boston : I wish to state that this 
case was never, properly speaking, under my care and 
treatment. I simply saw her for the purposes of study and 
diagnosis and turned her over to another physician. 



ABSTRACTS 
Die affektepileptischen Anfalle der Neuropathen uni> 

PSYCHOPATHEN (ThE EpILEPTIC AtTACKS OF AfFECTIVE OrIGIN 

IN Neuropaths and Psychopaths). By Oberarzt, Dr. Bratz. 
Monatschrift fur Psychiatrie und Neurologie. Bd. XXIV, H. 1 
und 2. January-February, 1911. 

Ueber Affektepileptische Anfalle bei Psychopathen 
(Affective Epileptic Attacks in Psychopaths). By Oherarzt^ 
Dr. Stallman. A llge meine Zeitschrift fur Psychiatrie. Bd. LXVIII, 
H. 6. 1911. 

Nicht-Epileptische Absenzen im Kindesalter. By M. 
Friedmann. Abstract in Allgemeine Zeitschrift fur Psychiatrie. 
B. LXVIII, H. 6. 1911. 

The articles deal with epileptoid attacks of affective origin 
occurring in early criminals and unstable degenerates". These 
attacks are similar to true epileptic seizures, but are differentiated 
from them by the facts that there is no mental deterioration 
following, that the attacks occur as episodes and are caused by 
some external stimulus, especially by mental excitement. The 
attacks may take the form of a vertigo, unconsciousness, or psychic 
equivalents, but attacks of petit mal do not occur. 

Convulsive seizures resembling grand mal attacks occur, but 
are rare. In these cases there are the symptoms of an epileptic 
attack, convulsions, biting of the tongue, pupillary rigidity, etc. 

There is still a smaller number of psychopaths who for years 
suffer from episodical epileptic-like attacks. When these patients 
are put into a quiet environment the attacks cease. These patients 
are usually badly tainted hereditarily, are emotionally unstable, 
and when they come into contact with the environment develop 
an increased excitability, thus leading to the affect-epileptic attacks. 

Petit mal attacks, which are characteristic of true epilepsy, 
do not occur in these psychopaths. 

Many authors have described different forms of attacks of 
vertigo or dizziness in the constitutionally nervous. The patients 
complain of a sensation of dizziness in the head, of a sensation as 
if they were looking through a veil, or as if everything was widely 
distant. The same patient may experience a great variety of such 
attacks. 

A sharp distinction between an attack of vertigo and one of 
fainting is not always possible when only a single attack occurs. 
The author gives a summary of a case in which besides the fainting 

304 



Abstracts 305 

attacks there were also so-called narcoleptic attacks. Of these 
latter there are two varieties: first, a true sleep coming on after 
mental excitement; and, secondly, abortive narcoleptic attacks 
in which the patient falls asleep for a few minutes but does not lose 
consciousness. A patient of Friedmann's became weak in the legs 
after a strong emotion. A case illustrating both varieties is given. 
In this case one of the most severe attacks of sleep or unconscious- 
ness occurred immediately after the patient had shot his bride. 
Other, light attacks occurred when he had a tooth pulled or when 
he saw blood. 

Periods of hallucinatory confusion and twilight states are, in 
the author's experience, of short duration, one-half hour to a few 
days, among the psychopaths. The disturbance of consciousness 
was not deep and the patients reacted to external stimuli. Con- 
trary to the findings in epileptic twilight states in which the attacks 
are most frequent, after grand or petit mal seizures, the attacks in 
psychopaths occur most frequently without preceding convulsive 
or fainting seizures. The onset was sudden, vertiginous attacks 
seldom preceding or accompanying them. 

In the author's experience attacks of depression leading to 
suicidal attempts are more frequent among these psychopaths 
than among epileptics. About one-third of his cases have made 
one or more attempts at self-destruction. On several occasions 
these attempts were the reason for committing the patient. Oc- 
casionally the patients have attacks of anger and excitement, 
which may lead to attempts at suicide. 

In collecting the histories of these patients the author finds 
that at the bottom of all the cases there is a psychopathic consti- 
tution. They do not attend school, remain away from home, 
many were detected in thefts or other offenses. In the institution 
it is seen that the ground for these offenses is the instability. In- 
stability and an unsettled mental state were the chief phenomena 
noticed. The emotional life shows a dulling and indifference with 
some tendency to brutality which, with the lack of self-control and 
an over-irritability, easily leads to explosive outbursts. In many 
there was a mental weakness, an intellectual deficit, but in very 
few cases was there a marked imbecility. On the other hand, 
there were quite a few who could be called normal intellectually. 
Homosexual practices, onanism especially, were very frequent. 
Intellectual deterioration was not noted in any of these cases. 
Neither the rapid mental decay which is seen in epileptics between 
the ages of fourteen and twenty, nor the gradual deterioration 
which occurs in chronic alcoholics occurred. 



306 The Journal of Abnormal Psychology 

Physically the patients almost always showed the symptoms 
of a congenital vasomotor neurasthenia. They were pale and 
the best treatment in the institution, with increase in weight, did 
not remove the pallor. Blood examinations showed no defect in 
the condition of the blood. Whenever the patient was a little 
excited, as in an interview with the physician, the pallor was 
succeeded by a blush. Sometimes the blushing and paleness 
alternated. Profuse sweating was also noted, but seldom over 
the whole body. 

Frequently there was hypalgesia or analgesia of the skin. 
Sensibility to touch was always normal. The author has never 
found the pain sense destroyed over half the body or over one 
extremity. 

Spasmophilic children frequently remain neuropaths when 
they become older. In these children the nervous irritability may 
be shown by the electrical reactions or by the mechanical over- 
excitability of the peripheral nerves and by the so-called Chvostek 
phenomenon. In testing the psychopathic and epileptic children 
with the two latter methods the author finds a markedly increased 
excitability in about half of the psychopaths and in only three out 
of twenty-eight epileptics. This shows that the so-called spas- 
mophilic symptoms are much more frequent in the affect-epileptic 
psychopaths than in epileptics of the same age. 

Various degenerative signs were found more frequently in the 
unstable psychopaths than in epileptics. General hypalgesia, 
which may be classed among the degenerative signs, was often 
seen. Hereditary taints were found in about eighty per cent of 
early epileptics as contrasted to ninety-six per cent of psychopaths. 
In many of these latter cases it was found that the father was 
psychopathic and alcoholic, or the father was alcoholic and the 
mother imbecile. 

In the greater number of cases the only external cause was a 
long lasting emotional strain which was more effective in causing 
the attacks than fright or sudden anger. In a lesser number of 
cases physical disability may also cause an attack of affect- 
epilepsy, such as infectious diseases, heat, and even acute alcoholic 
intoxication. 

The convulsive seizures of the psychopaths cannot be differ- 
entiated from genuine epileptic attacks. In both there is loss of 
consciousness, pupillary rigidity, jerking of all the limbs, biting of 
the tongue, and enuresis. But there are several distinguishing 
features. The seizures of the psychopaths are not so severe as in 
epileptics. Injuries are less frequent. The seizures are always 
single and status affect-epilepticus never occurs. Death has never 



Abstracts 307 

been noted in these cases. Enuresis and aurae occur less fre- 
quently than in true epilepsy. Petit mal attacks do not occur. 

The attacks of vertigo are easily distinguished from petit mal 
attacks. When they increase to loss of consciousness we speak of 
fainting attacks. The majority of these attacks are of short 
duration. The last pomt of diiferentiation is their episodicity 
and the fact that they are dependent on some external cause. In 
many of the less severe cases the external causes are not so promi- 
nent as to be useful as differential points when used alone, but in 
all these cases the author was able to demonstrate the external 
cause. 

The author does not attempt to prove that the aifect-epileptic 
attacks occur only in the neuropaths and psychopaths, but quotes 
from the literature many articles dealing with similar phenomena 
occurring in other constitutional conditions, such as psychasthenia. 
Agoraphobia and obsessions as described by Westphal and the 
tics, anxiety states, phobias as described by Janet and Raymond, 
are examples. Oppenheim has described the affect-epileptic 
attacks as occurring in the neurasthenics or psychasthenics who 
suffer from phobias and obsessions, a different group than the 
unstable degenerates. 

Alzheimer has noted the episodical character of the epileptic 
seizures in psychopathic children, especially at puberty, and 
remarks that the trouble has no relationship to genuine epilepsy, 
but stands nearer hysteria, from which, however, it can be differ- 
entiated. Spiller has noted that seizures occur in conditions other 
than epilepsy and hysteria. 

From a review of the literature one may conclude that many 
writers have seen convulsive seizures of a typical epileptic char- 
acter in neurasthenics, which are not epileptic and not hysterical. 
In the majority of cases, as far as one can tell from a history, there 
was an underlying psychopathic constitution. 

There are several theories as to the causation of these attacks. 
Liebermeister says that swooning attacks occur in circulatory 
disorders from fright, anxiety, or similar mental shocks due to a 
contraction of the cerebral vessels or to an overfilling of the 
splanchnic vessels leading to a cerebral anaemia. Weber found 
that there was a constriction of the vessels of the brain following 
unpleasant affective experiences, which is related to a dilatation 
of the abdominal vessels. 

In congenital neuropathic conditions this relation is disturbed, 
often reversed. From this the author concludes that the seizures 
in psychopaths have a definite relationship to the circulatory sys- 
tem and come from some disturbance of the circulation. 



308 The Journal of Abnormal Psychology 

In conclusion one may say: 

Episodical attacks occur In hereditarily tainted neuropaths or 
psychopaths of different kinds, in unstable psychopaths, in psy- 
chasthenics with obsessions, in hereditarily tainted, nervous children 
and in a number of cases of endogenous nervosity. These attacks 
occur usually In the first decade, are rare In the third decade, and 
are practically never present at the end of the fourth decade. The 
seizures are episodical, can occur singly or may persist for years, 
and disappear without any deterioration noticeable In the patient. 

Mental excitement, such as anger, sight of blood, etc., as 
well as physical causes, as Infectious diseases, great heat, alcoholic 
excess; and in children, anaemia and autointoxication may cause 
these affect-epileptic attacks. 

The attacks may be of very different kinds, such as, (1) grand 
mal, (2) attacks of dizziness (= vertigo), (3) fainting attacks,. 
(4) severe narcoleptic attacks, (5) conditions with failure of the 
motor musculature (slight narcoleptic attacks), (6) psychic at- 
tacks (equivalents). The attacks differ from epilepsy in that the 
grand mal attacks do not lead to status epilepticus and death, 
petit mal attacks never occur, attacks of vertigo are frequent. 
The differential diagnosis from hysteria can only be made by 
long observation and through the absence of the physical and 
mental phenomena of hysteria. The affect-epileptic attacks 
stand nearer to hysterical than to epileptic seizures. 

Stallman reports six cases In which there were typical epileptic 
seizures which were caused by some external stimulus, such as 
frustrated suicidal attempts or anger at being kept In the institu- 
tion. In none of these cases was there any intellectual decay. 
The patients all lacked the physical and mental signs of hysteria, 
and the author thinks that in every case there was a more or less 
high grade vasomotor neurasthenia. 

Friedmann found short " absences " In children, In which con- 
sciousness persists, but there is a momentary pause, an inability to 
move. The attacks occur after some excitement, such as a painful 
operation, the child stands motionless, gazes steadily upward. This 
lasts about ten to twenty seconds and the children know everything 
that passes about them. The attacks are repeated often, sometimes 
ten to forty times. The trouble is characterized by very short 
attacks, consciousness Is retained, the duration of the whole 
trouble Is rather long, but the development of the child is not 
hindered. Bromides have no effect on the frequency of the attacks. 

The basis of the trouble is not yet clearly demonstrated. In 
adults the relationship of the attacks to neurasthenia is fairly well 



Abstracts 309 

proven, but in children neither neurasthenia nor hysteria can be 
definitely said to be the cause. 

Charles Ricksher. 



A Note on the Consciousness of Self. By E. B. Titchener. 
American Journal of Psychology. Vol. XXII, No. 4, October, 1911. 
Pp. 540-552. 

A number of observers trained in systematic experimental 
introspection at Cornell University were asked to answer certain 
definite questions pertaining to the nature of self-consciousness. 
The first question relates to the continuity or intermittence of the 
experience of self. On this point Titchener's own testimony is to 
the effect that "the conscious self, while it can always be con- 
structed by a voluntary effort, is of comparatively rare occur- 
rence,"^ and Wundt writes in a similar vein, as when he states 
that the expression " 'forgetfulness of self ... is misleading, in 
as far as it is prompted by the tendency to consider reference to 
the subject as the normal . . . state of affairs." On the other 
hand, Calkins writes, "I am always, inattentively or attentively, 
conscious of the private, personal object, myself, whatever the 
other object of my consciousness"; and referring to the "material" 
self James states, "We feel the whole entire mass of our body all 
the while, it gives us an increasing sense of personal existence." 

The question was formulated around the quotation, "I am 
always, inattentively or attentively, conscious of myself, whatever 
the other objects of my consciousness," in two parts, as follows: 
"Is this statement true, as a matter of experience, (a) in everyday 
life, (b) In the introspective exercises of the laboratory.^" 

The replies obtained by Titchener from his students show 
differences of introspective ability, of attitude, of training, of 
point of view and, perhaps also, of interest in the subject. Never- 
theless they point to certain definite results, although Titchener 
is unwilling to claim finality for them. 

Eleven out of thirteen observers (seven men and five women) 
deny the persistence of self-consciousness throughout the waking 
life; of this number nine (six men and three women) deny its exist- 
ence even during introspective experience, not alone In everyday 
life. Even the two observers who affirm the continuity of self- 
consciousness qualify their answers so that Titchener feels himself 
justified to conclude that "self-consciousness is, in many cases, an 
Intermittent and even a rare experience," 

^Text-book of Psychology, 1910, 544 f. 



310 The Journal of Abnormal Psychology 

The second question asks for a description of the self-con- 
sciousness. Current psychological works record three ways in 
which the self may appear in consciousness: 

1. A certain class of mental processes may carry the self- 
meaning, " apart from any determination of present consciousness." 
For Lipps, for instance, conscious experiences are either conscious 
contents or self-experiences. The latter, feelings in the wider sense 
of the term, always appear together with the objective experiences. 
As Lipps states it tersely, "I always feel myself somehow." 

2. The experiences of self may be due to either an explicit or 
implicit determination. In the former case a characteristic group 
of conscious processes may carry the function of self-meaning. In 
the latter instance the reference to self is due to a particular ar- 
rangement and temporal course of the mental processes. Where 
this course or arrangement is disturbed, there can be no such 
special self-reference. 

As example of the explicit determination of the consciousness 
of self, Titchener quotes Wundt's statement that the self-experience 
consists "in essentials of a total feeling, whose predominating 
elements are the apperceptive feelings and whose secondary and 
more variable constituents are other feelings and sensations," 
kynesthetic, organic, etc. James's well-known reduction of the 
central, spiritual, active self to kynesthetic sensations In head, 
throat, and respiratory mechanism Is mentioned as a probable 
Instance (Titchener Is not altogether certain) of the Implicit de- 
termination of self-experience. 

3. The third view Is that the experience of self may inhere 
In the whole of one's experience, in the "warmth and intimacy" 
which, according to James, distinguish one's own Ideas from the 
Ideas ascribed to any "you." 

The question covering this point called for a description of the 
self-consciousness " as definite as possible. Is the consciousness 
of self explicit {e. g., visual Image, organic sensations) or implicit 
(intrinsic to the nature of consciousness. Inherent In the nature of 
consciousness).'' Can you bring out the character of the self- 
consciousness by comparing or contrasting it with other phases 
of a total consciousness?" 

The replies show that the reports fall naturally Into three 
categories: 

1. Those who affirm the continuous persistence of the self- 
consciousness as shown in their affirmative answers to question la. 

2. Those who answer la in the negative but lb In the 
affirmative, thus asserting that self-consciousness Is always im- 
plied In the Introspective attitude; and 



Abstracts 311 

3. Those who reply to both parts of the first question In 
the negative. 

The replies here show no evidence of a special class of sub- 
jective processes (Lipps). All the reports, with one possible 
exception, support the view that the experience of self is a determi- 
nation, either Impllclr (as "unified experience," as "my ways of 
thinking and acting," and in statements referring to the self- 
conscious experience as of fluctuating content) or explicit (for 
instance, one subject's "large, dark vagueness which represents 
my own mind"; another's "translucent rays projected from the 
chest," etc.). Probably In all cases of visual imagery and In many 
organic complexes the determination of the experiences of self Is 
explicit, although in most cases no sharp distinction can be drawn 
between it and the implicit consciousnesses. 

The constituents of the self-consciousness In their order of 
frequency, as mentioned In the reports, are as follows: organic 
complexes, 12; visual imagery, 10; affective processes, 8 (Implied 
in four other cases); kynesthetic complexes, 8 (probably in other 
cases merged In organic); conscious attitudes, 4 (as follows: 
(a) responsibility; (b) recognition of ownership of introspections; 
(c) ownership of experience; (d) activity in background of con- 
sciousness); verbal auditory images, 4; cutaneous sensations, 2. 

The third question was addressed only to those who (In re- 
sponse to question la) denied the persistence of the consciousness 
of self In everyday life and required a statement of the circum- 
stances under which self-consciousness Is likely to appear. All but 
one of the eleven observers show in their replies that the experience 
of self Is brought out under conscious social determination. It 
follows that the "spiritual" or "material" self would seem to be 
subordinate to the " social self," at least for this class of observers. 

The unusual or novel situation comes next in the order of 
frequency as factor to which the realization of the self is ascribed. 

From this TItchener concludes that "it Is not permissible" 
to define psychology "the science of the self as conscious" as is 
done by M. W. Calkins. Every one of the thirteen observers 
rejected this definition. 

J. S. Van Teslaar. 



REVIEW 

Increasing Human Efficiency in Business. By W. D. Scott. 
The Macmlllan Co., New York. 1911. 

Professor ScoU's book is a pioneer attempt to analyze the 
psychological elements in industrial occupations. It makes a clear 
and readable presentation of the chief mental factors upon which 
human efficiency depends. These factors are imitation, loyalty, 
concentration, wages, pleasure, love of the game, relaxation, 
practice and improvement, habit formation and judgment. 
Numerous examples drawn from di-fferent occupations show how 
the appeal to and the study of these processes tend toward 
greater economy and efficiency. 

The book is intended primarily for business men and, conse- 
quently, is written in popular, non-technical style. 

It might be suggested that most of the ideas set forth are 
matters of common sense. This is largely true because practically 
no experimental investigations or critical analyses of the processes 
involved, in even the simpler occupational activities, have thus 
far been made. It is none the less profitable to look at matters of 
common sense from a scientific angle, and thus to promote a more 
thorough investigation in these fields in order to determine whether 
coiyimon sense and general impression are correct, and finally, to go 
beyond haphazard observation. 

The book ought to be practically useful to busmess men by 
way of suggesting serious analyses and examples of the application 
of th-e psychological factors in securing maximum efficiency. It 
ought to prove valuable also to the psychologist by way of furnish- 
ing varied and practical illustrations of mental laws and processes. 

Daniel Starch. 
University of Wisconsin. 



312 



Vi 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



DECEMBER, 1912-JANUARY, 1913 



CONDITIONS FOR A HOME OF PSYCHOLOGY IN 
THE MEDICAL CURRICULUM^ 



MORE than any year since the early nineties the 
past twelve months have brought events in the 
field of psychology and medicine which deserve 
a brief appreciation and also a brief discussion 
of the demands they suggest. 

The last December meeting of the American Psycho- 
logical Association made the serious recommendation of 
including psychology in the medical curriculum. This im- 
plies a grave responsibility, considering the inevitably strong 
individuality which is bound to hold in our field, and which 
makes it a matter of wide differences of opinion as to what 
kind of psychology the medical student would get. This 
very last year has seen striking assertions of contrasts among 
psychologists themselves concerning the relation of psychology 
to the sciences (I merely refer to the book of Yerkes), and 
the psychopathologists are still busy emphasizing contrasts, 
such as psychopathology and psychiatry, and even psycho- 
pathology and pathopsychology, as if they were not merely 
inevitable differences of emphasis of subordinated issues, 
and chiefly apt to furnish food to those who are eager to 
exploit the discords of the great science of conduct and be- 
havior. 

Fortunately we can point to concrete achievements in 
several directions: 

Presidential Address delivered before the American Psychopathological 
Association in Boston, May 30, 1912. 

313 



314 Conditions for a Home of Psychology 

(a.) The appearance of a number of comprehensive 
studies of psychopathological methods and results like those 
of Gregor, Ranschburg, Ziehen, Franz, etc., giving special 
static methods a firmer foundation. 

(b.) The appearance of such works as Bleuler's on 
Dementia Praecox, putting into clear evidence the position 
of psychopathology within psychiatry. 

(c.) We can notice a certain clearing of the relations 
between Freudian and general psychopathology, which, odd 
as it may seem in the face of the Anglo-Saxon traditions, 
promise to be much more genuine and far-reaching on our 
continent than in Europe, and will, I hope, not lead to 
antagonism, but to a give and take of neighborly and com- 
mon work by persons who are ready to admit that they may 
be of different temperament and capacities, but that they 
can leave the acceptance of their methods to the test of trial 
and experience rather than doctrinal persuasion or dogmatic 
taboo. 

We have indeed made an effort to make this meeting an 
occasion to come even more closely together by inviting 
representatives of different lines of work and interests to 
discuss the same facts and cases, with the hope that the 
elimination of the differences of the material will make it 
all the easier to understand and compare the individual ways 
of formulating the problems and of marshaling the facts. 

There is no doubt that the teaching of psychology and 
psychopathology in a medical school must in the first place 
get its trend from the lines in which the available teacher 
is accustomed to work. Few are in the fortunate position 
to-day of having had the broad fundamental preparation 
which we now want to give our own students; and therefore 
there arises the problem of how to round off the task so that 
the special lines of preference of the individual worker and 
teacher do not give a one-sided aspect such as will provoke 
misleading contrasts and especially also undesirable criti- 
cisms on the part of those who want to protect the students 
against an excessive curriculum, or even take an a priori 
stand against the one or the other school or perhaps against 
all psychopathology. As a matter of fact we need only look 
over the available text-books of psychology and psycho- 



Adolj Meyer, M.D. 315 

pathology, or chapters on psychopathology in various works 
and the journal contributions of the possible candidates for 
chairs of psychopathology to realize what a difference of 
standpoints the students will have to face. And when we 
add to this even a modest list of what the medical practi- 
tioner and the public expect psychopathology to cover, or 
what they have fatal prejudices about, you will agree that 
the task presents features worthy of at least a summary 
discussion. 

As you know, I expect the best results if we succeed in 
making psychology and psychopathology a natural exten- 
sion of common-sense psychology and of the student's 
interests in normal as well as abnormal mental life, by en- 
couraging the biological attitude and conceptions^ with equal 
respect for the objective as well as the more or less subjective 
or introspective material, that presents itself to the ob- 
server. I say "more or less" subjective because to make 
the so-called introspective material an object of science, we 
certainly do all we can to pin down the evidence of its 
existence and nature and to prove it before others as well as 
before ourselves by just as searching evidence as physics 
demands for sound waves or electro-magnetism. In a 
measure as the introspectively most evident reactions obtain 
evidence of objective validity in the interplay of objective 
events can it become a valid topic of the science which de- 
scribes what its objects are and do. 

It is extraordinary how the short period since the human 
race has actually evolved and practised the methods of 
science has tended to corroborate a dualistic tendency which 
is exploited by some in ultrabiological claims and specula- 
tion, and in turn forces the scientist and the average man to 
accept our mental life naively as a mere world of subjective 
values, and to respect them as scientific or at least as dynamic 
only when translated into terms of various kinds of modern 
brain mythology. The change of attitude on this point is 
very slow. We are still looked at with suspicion when we 
claim that the emphasis on the so-called psychophysical 
parallelism is no longer obligatory, and that if we make a 
contrast it should be that of mental and non-mental biological 
reactions and not the illogical contrast of mental and phys- 



316 Conditions for a Home of Psychology 

ical. Only few admit, what we all assume in practical life, 
that we might well listen with some respect to the concepts 
of the plain man who speaks of mental forces, of mental 
causes and their effects. The firmness with which the 
orthodox parallelist attitude is officially adhered to was 
strongly brought home to me at the recent Berlin Congress 
of Experimental Psychology. The type of psychology 
which prospers within these restrictions is certainly im- 
pressive, but such an ever-growing and ramified structure 
of detail that one might cry out with Moebius the cry of 
hopelessness as to our finding common ground. 

Psychology and psychopathology in medical schools 
will succeed in a measure as we can offer a clear formulation 
of a body of facts enriching and balancing the common- 
sense experience, and assuring a well-defined gain over the 
untrained. It is natural that we should start with the dis- 
turbances in which- even our common-sense work has recog- 
nized a need of accurate methods, in the form of a mental 
status^ in the defect-states a reliable carrying out of the Binet 
tests, memory tests, and in the association tests. This is bound 
to lead to an extension into a study of processes and tend- 
encies and their conflicts, types of conduct and attitude and 
their determining factors, and this inevitably to the mooted 
field of the material which does not present itself clearly in 
the patient's mind, but which we have to learn to disclose, 
partly in terms of reminiscences or lines of more or less 
automatic reactions, or through evidences of interferences, 
resistances, symbolic disfigurement, etc. This inevitably 
necessitates the study of already analyzed and interpreted 
material of kindred cases and practice in the analysis of one's 
own life. All through the conditions had best be stated 
as conditions of adaptation to more or less clearly defined 
situations with a certain constitutional and experiencial 
material, and the degree of success to be determined and 
reduced to the terms of an experiment. The chief steps 
beyond the ordinary medical attitude are that the aim is not 
merely a determination of certain fixed symptoms which 
•dictate a diagnosis, — a procedure which is justified enough 
for preliminary orientation where the facts are simple, — but 
actually as close a reconstruction as possible of the mental 



Adolf Meyer, M.D. 317 

and non-mental factors which determine the course of 
events and the various reactions. 

It is quite obvious that this requires a decided broad- 
ening of the horizon and method of critical reasoning beyond 
what the student is usually trained for, and it seems to me 
worth while formulating an important step, viz., the sur- 
render of absolute quantities and absolute effects for relative 
or cofiditioned quantities and effects which, moreover, the 
student must learn to handle by seeing them, not as inde- 
pendent entities, but as parts of balancing processes. 

What discourages the layman or student most is the 
relativity oj all the factors with which he has to deal in our 
field. He is trained chiefly in the so-called accurate or 
absolute sciences, in which the mass, the specific weight, 
temperature and the chemical constitution and form, etc., 
determine about all that defines the nature and potentialities 
of the object. Moreover he assumes that a factor must act 
like a set dose of a chemical and produce certain eflFects, or if 
it does not, it cannot be considered as a cause, becomes un- 
reliable and negligible. 

To learn to work with the highly conditioned entities 
he must be given a standpoint on which the conditioned 
character of his facts remains plain, and on which he never- 
theless learns to appreciate safe relative measures and stand- 
ards of test and control. 

Biological forces and especially psychological forces 
have this in common that the quantity of mass and energy 
expressible in chemicals and in stored energy plays a rela- 
tively unessential role as compared with the qualitative 
features which show in the different associations and which 
I might call ''xht fitness for the task." 

As James says: "The measure of greatness. here is the 
effect produced on the environment, not a quantity ante- 
cedently absorbed from physical nature." To give the 
student an idea of these forces, we must show him the re- 
active mechanisms and available reaction types whose trig- 
gers the specialized force is able to pull. 

The problem thus becomes the introduction of accuracy 
into a field which seems to resist the common methods of the 
simple and more purely objective sciences. 



318 Conditions j or a Home of Psychology 

We do well to direct, our students to a tendency which 
has worked itself out in quite a few minds during the last 
decade, and which I am glad to find expressed and empha- 
sized not only by the psychologist and psychopathologist 
who needs it most, but quite explicitly and consciously by 
the naturalist in the more orthodox quarters: Mach and 
Kirchhoff in physics, Roux in morphology, Verworn in 
physiology, and von Hansemann in pathology (Ueber das 
conditionale Denken in der Medizin). This tendency is the 
transformation of the naive causal conception of events and 
facts into a more modest conception of determination of 
conditions free of the presumption that, by stating the one 
element of a variation of a state or process, that determina- 
tion of the one element alone would be a complete and ac- 
curate statement of the causal value in any situation under 
consideration. The relativity of individual factors, the 
conditioned value of every one of the factors with which we 
deal, puts psychology on a basis where much more caution is 
needed than in any other domain of human experience and 
analysis, and for which we also have special helps. The 
average individual is a good enough reagent to react relia- 
bly and safely and in keeping with the laws of probability 
and something like absolute pitch so as to justify within 
certain limits such a psychobiological law as Weber's, but 
even there and still more in the more complex reactions, the 
safety of the predictions is only relative, almost always con- 
ditioned by more factors than we can control; a concession 
which would only be an apparent excuse for the resignation 
of those psychologists who declare themselves ready to 
sacrifice all claims to a dynamic consideration, and who hide 
themselves behind a methodical dualism, and possibly be- 
hind that worst type which contrasts physical and mental 
facts. The point is that we should and do react sufficiently 
safely to determine certain important conditions of events. 
To learn to state the setting in which factors play a certain 
role, to learn to modify the factors and to determine safe 
conditions for certain results, is the fundamental problem 
in all our work, and the fact that independent measurement 
alone is not feasible need not perplex us. 

In this direction nothing will help but training in a 



Adolf Meyer, M.D. 319 

similarly safe conditional presentation of any facts which 
we must look upon as the parts integrated in the whole of 
any biological, neurological, or general physiological re- 
action. While the elementary sciences pride themselves on 
getting along with elements which stand by themselves, 
embodying as it were with fatal necessity all the effects into 
which they can be led, the living organism, owing to its 
complexity, baffles the demand for regularity in many points. 
Hence the temptation to fall into the mistake in which men 
like Loeb get involved when they believe that only a rigid 
mechanistic conception of nature can eliminate mysticism, 
and that any recognition of conditioned reactions and any 
temporary acceptance of a measure of factors in terms of the 
effect produced in the completion of a known process, in an 
Aufgabe or task, is teleology. Simply because there really 
occurs in benighted quarters such a thing as unwarranted 
mystic teleology, the entire logical formula of seeing parts 
in the light of a whole is to he replaced by, however hypo- 
thetical, constructs of elementary units, or is at least to he 
discredited. I should, on the contrary, urge that the training 
in physiology put much more emphasis on the definition of the 
conditions under which ends are attained. The student needs 
practice in this form of presentation in matters where errors 
would be easy to demonstrate. Only with such preparation 
will he then learn to see the conditioned share of bacteria 
in infection and symbiotic reactions, the conditioned effects 
of poisons such as morphine which a cow can eat without 
narcosis; the conditioned effects of sera, and the conditioned 
effect of the so-called causes of nervous and mental disorders, 
and the variability of the form of appearance, and especially 
also the nature of symbolism, which seems to be the red 
flag to the bull to the orthodox critics of modern psycho- 
pathology. 

This has many important implications which I want to 
illustrate briefly. Psychology is forced to get square with 
that simplistic temptation to take detail reactions such as 
sensation, or any other relatively independent units of re- 
sponse, and to give them at once the independent position 
of reaction of a special independent organ or of nerve cell- 
groups, even independent of receptive and effective organs. 



320 Conditions for a Home of Psychology 

I thus should have to ask for caution at the v^vy 
foundation of the teaching concerning reflexes. Reflexes are 
the simplest processes of neurobiological adaptation. As 
a matter of fact we demonstrate such fundamental reaction 
as reflex-activity at its best in a spinal frog, or in a detached 
lumbar animal, i. ^., enough of a central mechanism attached 
to receptors and effectors to be sufficient for a reflex-entity. 
We can, of course, penetrate further and study this funda- 
mental mechanism in more detail. We can take the nerve- 
muscle preparation, or the Kiihne experiment, or since we 
know from anatomy and histology types of neurones and 
groups of neurones of special type of appearance and con- 
nection, we think of the independent activity of these types, 
perhaps with insufficient regard for the fact that however 
independent they may appear from the point of view of 
growth and maintenance, neurologically they have their 
position not as such but as parts of mechanisms. 

To reduce the data to the schematic reflex arc, and 
especially to individual neurones, means cutting it down to a 
conceptual minimum inviting dangerous conceptions of 
simplicity from which many a student cannot recover, and 
which he carries wholesale into the field of the more highly 
conditioned psychobiological reactions; especially because 
the latter is already prepared in a similar way so as to work 
with independent units and elements — the independence of 
which must, however, be surrendered when we make of 
psychology the science of mental activity and its disorders 
in the sense of problems of biological adaptations. 

Perhaps the best analogy and guidance for the medical 
student comes from serology, dealing with a similarly high 
biological reaction type which exposes one very little to the 
hope that we can assign the specific function to definitely 
known parts in the immediate future; a type of reaction 
which must at this stag« be considered in terms of regulation 
and adaptation of the organism as a whole. 

We deal with systems of balance and systems of adapta- 
tion; and within these we may push the details of reaction 
referring more especially to sense-organs, or to motor mechan- 
isms, or depending more on the central organization and 
the material of constructive imagination, and the adaptive 



Adolf Meyer, M.D. 321 

play of emotions; but after all we do well to avoid the 
simplistic notion, that we can dispense with the reference to 
the whole system and to the aufgahe or task. We study the 
detail as relatively independent integrative factors, and train 
the student to observe the essential fact of how much of 
the personality must be intact for a function, and what 
situation or task it fits into in the performance of its func- 
tion. 

The next consideration on which we must demand 
better training in the student is that of time, i. e., that of the 
necessary steps and sequences for the assurance of an adapt- 
ive reaction, a point concerning which the student must 
develop his scientific conscience if he wants to be true to 
the world of events, and if his predictions shall carry correct 
prognostic values. We must relieve him of the feeling that 
scientific simplicity demands a kind of telescoping which is 
apt to lead to serious disregard of the actual chronological 
sequence of the various factors or conditions. 

If we are to become clearly helpful to the medical 
student and physician generally we must help him complete 
his ways and methods of sizing up and handling usual and 
unusual mental states better than he can now under the 
dogma of neurologizing tautology — that vain feeling that 
there is an independent world of psychics, but that only 
those facts are scientific which can be reduced to terms of 
brain cells, and also the notion that all facts of pathology 
worth knowing can ultimately be telescoped into the notion 
of some lesion, whereas we really always find most safety 
in series of events which may differ according to the sequence 
in which the elements enter into function. 

We must be able to help him give a reliable and helpful 
and suggestive description of his cases, and not merely a 
rigmarole of faddist terms and phrases which change from 
man to man and from year to year. We must be able to 
carry the conviction that we point to observable facts or 
factors without which the vital conclusions about a case 
simply cannot be drawn correctly enough. A feeling for 
economy and safety must of course mark our methods of 
examination and also a direct applicability of the results 
to our diagnostic and practical conclusions. We must give 



322 Conditions for a Home of Psychology 

the student guidance in the static and dynamic sizing up of 
personalities and situations and conditions, and a courage 
to use his native sense. Like every other science, psychol- 
ogy and psychopathology must show that it brings safe 
facts not already equally well known without all the work it 
calls for, and not merely amplifications of the obvious, and we 
must furnish the understructure in the form of safe data of the 
evolution of the 'HrieF^ life, such as the evolution of the sex- 
life, and of related or of more independent trends and their 
conflicts, the craving for various gratifications, cravings for 
protection, for revenge, for justice or what not, or the con- 
flicts between imagination and reality. 

Personally X look in the events for the factors of psycho- 
biological reaction, and study them for the conditions under 
which they occur, the differentia tive marks of the different 
conditions, the factors principally at work and the means 
for their modifiability. The facts thus singled out must then 
be studied under various modifications of conditions. We 
find most accessible to our study those that can be produced 
at will, sleep and sleeplike states, states of hypnotic dis- 
sociation, states of fatigue and of toxic modification; and on 
the more essentially mental side, states of preoccupation, of 
conflicts, of cravings, of wish, of substitutive gratification, 
of repression, of symbolization {i. e., facts which cannot be 
grasped by those who have raised the scientific use of ele- 
ments to the point of negation of larger units, in the light of 
which alone such a fact as symbolization can have a sense). 
The chief weight is to be laid on the known conditions of 
modifiability of the integrative factors of adaptive re- 
actions. 

A serious issue is a safe knowledge of the extent to which 
reactions can be induced and can be made to play an active 
part in the problem of adaptation of the personality to the 
situation and adaptations of the situation to the needs of the 
person. Thus we learn to single out certain mechanisms, 
functional if not structural, representing the clinical en- 
tities worth differentiating and forming safe settings for 
details. We should above all things impress the student 
and the public with the fact that the non-mental factors and 
the mental factors are made of similar stuff, and that they 



Adolj Meyer, M.D, 323 

cannot safely be viewed apart or intrusted to any one who 
has too strong a bias or deficient capacity or training in the 
one line or the other. There are sad tales on both sides. I 
am thinking of a case qualified as butchery and mutilation 
by the patient herself perpetrated in a woman with a psy- 
chosis from sexual maladjustment, but also an occasional 
case where too ready and final assumption of a hysteria 
sealed the chances of a case of brain tumor, or of a merely 
apparently defective child, or of a symptomatic reaction. 
In justice to the patient and to medical experience we should 
also keep account of the at least relative value of approved 
traditional ways of handling reactions, the pharmacological 
effects of a timely reduction of tension by bromide and other 
helps, and at the same time the existence of reactive tend- 
encies which would require functional investigation and 
adjustment. We can make it plain that a functional state- 
ment of the facts does not and should not disregard the 
organic facts involved; that sometimes the Tion-mental integral 
components and sometimes the mental ones offer the most 
effective modifiability or offer the explanation of why they 
are or are not modifiable. Moreover — and I say this with- 
out being an advocate of a medical trust — only the broadly 
trained physician can remain free of the charge of opening 
the door to the (^-scientific if not <2n/z-scientific; nobody can 
fail to recognize the responsibility of adequate knowledge 
about all the integrative material with which we work. On 
the whole we do well, I think, to advise our psychological 
friends to choose at least as an avocation a medical training 
which I hope will some day figure as a worthy source of 
general culture, and as a good way to learn to know the 
human machine and its vicissitudes in the broader relations 
of life. 

Critical control of the induction of mental states, such 
as suggestion, persuasion, etc., should furnish one of the best 
means of measuring the relativity of the dynamics of mental 
forces. Judgment on this point is, however, difficult to 
obtain. As a matter of practice, it is desirable to make sure 
of the actual facts personally or through a third person, by 
controlling what the patient understood and carried away 
from medical advice, — a duty unfortunately shirked as a 



324 Conditions for a Home of Psychology 

rule but at the cost of a great deal of the superstition and 
gossip that surround medical advice, and at the cost of 
much imagination on the part of the physician. 

The great responsibility of investigating and regulating 
the sexual life of patients and the extent to which sexual 
life has proved to be of importance all through the pathology 
of neuroses and psychoses, and the prominence of so-called 
moral principles in the work of mental hygiene and cure 
naturally throws another burden on the teaching of psycho- 
pathology. The physician must here, as in the teaching of the 
non-mental physiology, transgress the customary aloofness 
of Science with its capital S. Without tact and a clear 
foundation much harm can be done. Matters have come 
to the point that the position of a physician in a new hospital 
recently was made dependent on the disgraceful condition 
imposed by the trustees that neither hypnosis nor psycho- 
analysis be employed. On the other hand teachers and 
ministers have carried dangerous inferences into the school- 
work with the inevitable result of grievous misunderstandings 
if not worse consequences, and a setback to a simple and 
steady growth of our work. 

Psychopathology is bound to be the agency through 
which many excessively rigid and cut and dried rules of tra- 
ditions of conduct of one's personal life and of social con- 
ditions will be broadened out. A few years ago in some 
lectures at Ithaca I spoke of the solidarity of mental hygiene 
and ethics. May this be made possible through a sane ac- 
cumulation and utilization of facts and a gradual evolution 
of helps making for unification of biological and ethical 
views, and for a broad orthobiosis. That this means a de- 
parture from the purely mechanistic and purely statistical 
views of the world and a restitution of a perhaps more tem- 
peramental conception of things with acknowledgment of the 
mechanistic and statistical methods in their proper setting, 
need hardly be questioned. 

* Among ourselves we have to cultivate a true and direct 
formulation of the lay-concepts, their presentation in our 
trained view of the facts and only then a transformation into 
technical concepts until we shall have worked out ways of 
certainty that we see, mean, and handle the same ehings. I 



Adolf Meyer, M.D. 325 

should especially urge those who work with Freud's methods 
to be somewhat sparing with the use of terms with too many 
implications, such as Uebertragung, unless they are sure that 
the hearer has had his foundations adjusted. 

A general idea of what training in psychopathology 
should be has been mapped out in connection with the 
English plan of creating a special diploma in psychological 
medicine. The best formulation will no doubt be the work 
of a psychopathic hospital. There we get the concrete prob- 
lems and the organized efforts to get square with them. 
They will, I hope, implant in the public, and especially the 
medical public, such a familiarity with concrete facts as will 
correct the outcroppings of phantastic literature and one- 
sided conceptions and expectations of the domain of psycho- 
pathology, and also shape a natural curriculum in our new 
courses. 

In this our meeting let us see that as far as possible we 
make it plain what our own standpoints and conceptions are, 
rather than pointing out the errors of the ways of others. Criti- 
cisms in the form of questions, and not defenses but ex- 
planations, will help us on the difficult path and make the 
meeting one of general usefulness and lasting pleasure. 



ON THE SOMATIC SOURCES OF SOMATIC 
DELUSIONS 



{From the Laboratory of Danvers State Hospital^ . 

THE small group of cases which I here present was 
obtained by the rigid application of certain routine 
standards of classification cases characterized (1) 
by delusions mainly and essentially of somatic 
type, which cases (2) were later autopsied and (3) failed to 
show obvious brain lesions. The eight cases described repre- 
sent all that remains of a group of one thousand autopsied 
cases of mental disease when subjected to the said analysis. 
My object was to determine whether, after excluding de- 
lusions possibly of brain manufacture, there remain any 
delusions of the severe, essentially somatic type in patients 
having a normal sensorium. All eight were found to be 
subject to severe somatic disease and, to a large extent, such 
somatic disease as to offer ready material for delusional 
transformation. The data seem to show that the content 
of "organic sensations" may well have somewhat to do with 
the quality of the delusions developed and very possibly with 
their imperative character. 

Somatic delusions, or false beliefs concerning the body 
and its parts or organs, form logically a very broad and 
heterogeneous group of delusions having doubtless a great 
variety of causes. I wish here to consider a special group 
of somatic delusions, those which impute to the organism 
various structural disorders of its parts. Those rather 
more functional disorders of the body which form the subject 
of the hypochondriac's complaints and surmises, although 
closely related to the structural group here in question, are 
not the first object of my study. I propose rather to con- 
sider the seemingly more profound, less shifting, quite 
unnatural beliefs which impugn the integrity of the organs 
themselves and ascribe to them the most surprising, fantastic, 
or grotesque characters, which nevertheless possess the center 
of the stage and dominate the lives of the believers. 

^ Danvers State Hospital Contributions, No. XX, 1912. 

326 



E. E. Southard, M.D. 327 

The domination of these somewhat persistent somatic 
delusions is perhaps no more powerful than domination by 
sundry delusions concerning personality or concerning the 
attitude of society. Yet the latter types of delusion, say 
of personal grandeur or of persecution, find in all of us more 
childhood memories of maladjustment than do the utterly 
absurd somatic delusions, say of a snake in the stomach or of 
silver knives in the legs. The delusions of personality at 
large and the delusions concerning social environment we, 
as human beings, regard as not very unlike normal shiftings 
of the ego in the midst of other egos. Yet, should we find, 
as in a case narrated to me, that the woman with a snake in 
her stomach was actually a victim of tapeworm, or, as in 
a case I saw, the man with knives in his legs had been a pro- 
nounced alcoholic and presumably suffered with the relics 
of neuritis, we should see clearly that the transition from 
sound beliefs to unsound beliefs is perhaps no more difficult 
in the somatic group than in the personal and social groups 
of delusions. 

The question whether a belief is true or false is perhaps 
most easily dealt with in pragmatic terms. Transitions and 
intergrades between true and false beliefs perhaps exist. It 
may be, and some are inclined to conceive that there is, in 
some sense a quantitative scale of morbid beliefs, that the 
lighter obsessions and fixed ideas, the morbid imaginings of 
neurasthenics and psychasthenics, the steady stream of 
abstract morbidity — and mortality — concepts in sufferers 
with what used to be called hypochondriacal melancholia, 
and the intense, concrete, focalized, fixed conceptions of 
organ destruction and perversion of the group I here con- 
sider, are all of a piece, genetically speaking. The dominant 
idea concerning delusion-formation is probably that de- 
lusions express a general morbid alteration of brain function, 
such that the personality reacts abnormally to the data it 
receives. The modern alienist would hesitate to localize 
either the process of delusion-formation in general or the 
concrete process in any particular case. Delusion-forma- 
tion, on this account, is a reaction not far removed from 
normal reactions, a perversion of the believing process, dis- 
tinguished from that of the true believers {i. <?., oursevles, 



328 On the Somatic Sources of Somatic Delusions 

the sane public and proper constituents of society) in little 
but a mental twist that does not work, is not pragmatic. 
Thus a pragmatic belief would be a true belief. A delusion 
as we see it might assert itself as a belief by becoming useful, 
consistent with evolution, pragmatic. 

Surely the somatic delusions, which impugn the very 
structure of body organs and impute to them impossible 
characters, are at the very pitch of the unpragmatic. Doubt- 
less what the dominant theory asserts is true so far as it 
goes. The deluded person interprets falsely the data that 
you or I would not interpret falsely. At least our own false 
beliefs are transitory and of little weight in our lives. For 
the deluded or paranoid patient the false beliefs are at his 
pragmatic center, and often drive him out of society. 

There is another and more neglected . feature of the 
situation. One may (a) interptret data falsely, but also (b) 
receive jalse data for interpretation. In the latter event one's 
interpretation may be true or false, but the chance of one's 
being very pragmatic is remote. 

I should not introduce these truistic remarks if I did 
not believe that there is some chance of resolving these 
groups of delusions in actual cases. Of course the outlook 
is not bright. I remember remarking to a bystander at an 
autopsy that the delusion of a certain patient that she had 
furniture piled on her belly might possibly be correlated with 
certain rare iibromyomatous tumors that I found in the wall 
of the stomach. Thus, impulses of an abnormal character 
might accrue from the viscus in question and be referred to 
the abdominal wall, only to receive the peculiar interpreta- 
tion as above. But, the bystander remarked, for every such 
case of supposed correlation I can show you another, or 
several others, without such somatic basis. 

I was aware that, however many striking instances of 
apparent correlation between somatic delusions and somatic 
lesions I could adduce by a questionnaire method, I should 
remain with the feeling that the correlation was fortuitous 
or incidental. 

As it happens, however, I could choose a proper series 
for study upon a statistical basis. The Danvers State 
Hospital staff had for some time been using an approxima- 



E. E. Southard, M.D. 329 

tion to the Wernickean classification of delusions as referred 
(1) to the self or autopsy che, (2) to the outer world or allo- 
psyche, and (3) to the body as represented in the somato- 
psyche. I cannot say how consistently this classification 
has been used or whether it is the most satisfactory possible. 
At all events our cases have been assorted into groups such 
that alterations in personality, altered social conceptions, 
and obvious strange ideas about the body and its organs 
can be readily found statistically. 

I chose my cases for investigation as follows: 

1. Only autopsied cases were considered, not merely to 
give the somatic basis the best chance to be observed, but 
also to get the benefit.of a finished clinical record. 

2. From a series of one thousand autopsied cases of all 
available sorts of mental disease, about seven hundred cases 
were excluded because of obvious gross cortex lesions which 
might be thought to pervert the judgment process itself or 
even manufacture in the brain itself false data for interpreta- 
tion. I mean to return to this group of cerebral cases of 
delusion-formation {e. g., general paresis) in a later study. 
Meantime I have excluded such cases, believing that the 
normal brain, if we could find some, would be the best in- 
strument for showing the operation of somatic false data in 
delusion-formation. 

3. In the residue I thought best to consider only those 
with relatively pure somatic delusions, fearing that the ele- 
ments of disordered personality and of estranged reaction 
to the external world would be considered sufficient to crys- 
tallize out such somatic delusiosns as might appear in com- 
bination with personal and social delusions. 

The rough initial classification of the chosen group 
was as follows: 

Cases without gross destructive lesions, 306. 

Cases listed as showing somatic delusions, 38. 

Cases listed as showing somatic delusions only, 10. 

The group of cases at which I arrived by this statistical 
process is an extraordinarily varied one. All suffered from 
severe somatic disease and several showed somatic disease of 
such a character as to present a number of unforced correla- 
tions with the delusions found. The cases are reported, 



330 On the Somatic Sources of Somatic Delusions 

both clinically and anatomically, with very various degrees 
of fullness; but, except in one case, perhaps the most striking 
data are preserved. 

One case of the ten had forthwith to be excluded from 
the group, inasmuch as microscopic examination showed such 
chronic degenerative processes with mild exudation in the 
various parts of the cerebral cortex as even to rouse the sus- 
picion of general paresis. Here then was a "grossly normal" 
case which was actually abnormal microscopically and in 
such wise as to offer a sufficient general basis for delusion- 
formation on falsified brain data. The case, which showed 
marked somatic delusions of negation, has been published 
by Mitchell and the writer as Case III in our study of 
"Melancholia with Delusions of Negation: Three Cases with 
Autopsy," Journal of Nervous and Mental Disease^ 1908. 

In a second case (C. W., D. S. H., 6977, Path. Lab. 367) 
I find that the delusions classified as somatic are at best 
merely incidental in a flight of maniacal ideas in a woman 
observed for but four days before her suicide, and are in part 
possibly not delusions at all, but rather slightly altered true 
beliefs concerning injuries received, some of which were in 
evidence at the autopsy. 

The series was thus reduced to eight cases, in which 
the important delusions found were somatic, but in which 
there was no clear evidence, at first blush, of falsification ol 
data in the brain itself through plain lesions of the cortex. 

The eight cases vary in character. In two (Cases I 
and III) the somatic delusions were brief but imperative, and 
so suggestive in their possible correlations that I include 
them in this discussion. The remainder are more of the 
accepted type of severe essentially somatic delusions. 

The eight cases thus come at are not all alike. I will 
present the less typical first because of instructive comments 
which they afford. 

Case I (M. D., D. S. H., 8108, Path. Lab. 545) was a 
young woman, probably dementia praecox or an imbecile of 
high grade with katatonic features. Ten days before her 
death (at the age of twenty-seven, some five years after 
onset of pronounced mental symptoms) she complained that 
a fellow had come into her room in the night and shot her 



E. E. Southard, M.D. 331 

with a seven-shooter. She could point out no wound, but 
felt local pain. On physical examination, pleuritic friction- 
sounds were heard in lower part of left lung. The autopsy 
showed the pleurae extensively adherent by old adhesions, 
except in the area just mentioned where fresh fibrinous exu- 
date was found without fluid. There was extensive phthisis 
with cavities in both upper lobes, caseation and gray hep- 
atization of right lower lobe, numerous tubercles in left 
middle lobe, and edema of left lower lobe. Microscopically, 
Dr. W. L. Worcester found slight acute alterations of nerve 
cells in five cortical areas, hyaline degeneration and eccentric 
nuclei in certain Betz cells and certain large cells of bulb. 
There was also in the vascular sheaths of the cortical vessels 
considerable accumulation of pigment granules. Perhaps, 
therefore, this case should not count as one of normal brain. 
I include it because the brain changes are slight and the 
somatic delusion and its physical correlate are so sharply 
defined. 

Case II shows a somewhat similar correlation of a lung 
disorder with a delusional content expressed in localized 
kneading of the body. 

E. W. (D. S. H., 7363, Path. Lab. 563) was a clerk of 
fifty-four years, who had developed insomnia, depression, 
and suicidal attempts some three months before admission, 
December 4, 1893. Grandfather a suicide. Father had 
been a suicide at fifty-three years. Brother a patient at 
Danvers. 

Two suicidal attempts, by opening arm vein and by 
penknife and scissors stab to reach heart, preceded commit- 
ment. The diagnosis of hypochondriacal melancholia was 
made. '^ Torpidity of the bowels^^ was the chief complaint. 
Patient took patent foods between meals and kneaded right 
side of chest and abdomen till they were black and blue. 
Sleep was "unnatural," later denied to have taken place. 
Exercise was of no use. "Constipation," "heat and cold 
in limbs." Meantime ate and gained somewhat in weight. 
Abscess in neck in May, 1896. Wore overcoat in all but 
warmest weather. Cough and fever, 1899. Eats little 
as he has "no stomach." Pulmonary signs. 

Autopsy by Dr. W. L. Worcester showed right pleura 



332 On the Somatic Sources of Somatic Delusions 

adherent to lung, which was hepatized in its entire posterior 
part. Left pleura free; early infiltration and edema of 
posterior part of left lung. Chronic cystitis (Streptococ- 
cus apparently in pure culture.) Microscopic examination 
of several scattered areas of cortex by the Nissl method 
showed slight acute changes. 

Case III (D. S., D. S. H., 13114, Path. Lab. 1078) was 
a case in which the somatic delusion was again a belief not 
far transformed from the truth. In fact Case III might 
almost be regarded as a "symptomatic psychosis." He was 
thought to be full of hypochondriacal ideas, as, "My stomach 
is full J and I can't eat anything.''^ Patient, who was an Irish 
currier of uncertain but advanced middle age, was a quiet, 
feeblcj amnestic, sad man who had apparently been irritable 
and perhaps subject to delusions of persecution for some 
months before admission. Signs of intestinal obstruction 
shortly appeared, and other signs warranting a tentative 
diagnosis of abdominal cancer. Autopsy, by Dr. H. A. 
Christian, about six weeks after admission, showed a 
carcinomatous obstruction of splenic flexure of colon, involving 
pancreas, retroperitoneal lymph-nodes, gall-bladder, and 
liver. The transverse colon was adherent to stomach, and 
both to under surface of liver. 

Cases IV and V are both characterized by certain de- 
lusions about the osseous system and, curiously enough, on 
autopsy proved to have structural changes in certain bones. 

Case IV (S. H., D. S. H., 1007, Path. Lab. 833) is a 
single woman, 3 times in McLean Hospital before admission 
to D. S.H., October 27, 1879, at age of thirty-three. She was 
given the diagnosis chronic dementia. "Has a noise in her 
head, which is caused by bees inside her skull.'' Patient 
seems to have thought also that she was blind. At times 
incoherent, quarrelsome, noisy at night. As a rule sat 
persistently in a certain seat; in 1902 had a spell of keeping 
h^r fingers in her ears. 

The autopsy (Dr. A. M. Barrett) showed death due to 
general carcinomatosis, primary in the breast. Whether 
the nodules of cancer found both macroscopically and micro- 
scopically in the pituitary body, which was as a whole en- 
larged, can be related at all with the delusional blindness is 



E. E. Southard, M.D. 333 

doubtful. More suggestive is a curious and rare condition 
of soft cranial bones. In one region in the right parietal 
bone there was a spot so soft that it could be scraped out 
with a blunt instrument. The cranial bones were not in- 
creased in thickness; the dura mater was moderately ad- 
herent to the calvarium. The other findings were either 
mild chronic lesions (chronic nephritis, adhesions of left apex) 
or lesions incidental to the terminal disease (carcinoma of 
lungs, bronchial lymph nodes, suprarenal bodies, fatty heart, 
fatty liver, focal necrosis of liver). 

Case V (F. M., D. S. H., 2304, Path. Lab. 1027) was an 
unmarried moulder of thirty-nine years, who was thought 
to have been addicted to masturbation for years, and had 
had typhoid fever and malaria in the Civil War. It is 
stated that patient was delirious after typhoid fever for 
some three months after return from the war. Then for 
some eighteen months patient lay in bed with legs drawn up. 
The somatic delusions {v. infra) then developed. The 
physicians' certificate spoke of "idiocy developed into im- 
pulsive and rnoral insanity." The patient was always of 
very doubtful diagnosis, but was given that of chronic mania. 
He is described as a "phenomenal liar, mixing nine parts 
lies to one of delusions." He believed on admission that 
his '''left clavicle was out of place ^"^ but apparently had no 
other delusions. There were occasional outbursts of ex- 
citement with assault, apparently accompanied by active 
auditory hallucinations. It was at one time thought that 
patient had nocturnal convulsions. 

During his long stay (April 26, 1882, to death, December 
17, 1905) patient had many ups and downs, but was fre- 
quently on parole. November 12, 1900, told a long story 
about his hand. Several fingers on each hand formerly be- 
longed to different individuals. Has made exchanges of 
fingers. His real face is concealed by a perfectly fitting mask 
that no one perceives. These stories were retold by patient 
for years. 

Occasionally profane and obscene in speech, even before 
women: after parole was removed, improvement. A year 
or so before death the delusions seemed to wear off. Once 
patient said the finger idea was a joke. 



334 On the Somatic Sources of Somatic Delusions 

Autopsy by Dr. A.M. Barrett showed remsLvksibW jriable 
ribs and a form of chronic osteitis of the occipital and posterior 
parts of the parietal bones, whose inner surfaces showed finely 
undulating surfaces. No special examination was made of 
the bones of the face or hands. The spine showed kyphosis. 
The spleen weighed 870 grams and seems in several ways 
consistent with the history of malaria about forty years 
before. The liver was also moderately enlarged (2310 
grams). 

Cases VI and VII must apparently be regarded as 
"symptomatic psychoses" incidental to tuberculosis (Case 
VI phthisis of perhaps sixteen months duration, Case VII 
fistulous, later miliary). 

Case VI (W. B., D. S. H., 5035, Path. Lab. 278) was an 
undertaker of fifty-eight years. His business was regarded 
as the exciting cause of what the old records term a mono- 
mania. The delusion consisted in the belief that his bowels 
were dead and that he was ^' all ruptured.'''^ He constantly 
declared that he could not eat, but did eat, nevertheless, for 
a time. A refusal to eat was met by the physician with a 
threat of tube-feeding, whereupon he began to eat again. 
The dominant and constant idea was the deadness of his 
stomach and intestines, about which he talked to any one who 
would listen. The pupils were sluggish; the knee-jerks 
exaggerated. He had always been nervous and, before 
admission, had threatened suicide and violence to others. 
There are no available data concerning heredity. The 
diagnosis was hypochondriacal melancholia. Emaciation and 
a few bronchial rales were observed on admission. The 
patient failed gradually and died about sixteen months after 
•onset (hospital stay three months, twenty-three days). 

Autopsy by Dr. A. H. Harrington showed a large 
tuberculous cavity extending four-fifths inch downward 
from the left apex and pleural adhesions on the left side. 
The condition of the intestines is not recorded. 

Case VII (D. C, D. S. H., 5151, Path. Lab. 397) was a 
painter of fifty-four years who was admitted after four 
months of similar symptoms, February 7, 1888, with the diag- 
nosis of melancholia, which was elaborated by the hospital 
physicians to chronic hypochondriacal melancholia. He had 



E. E. Southard, M.D, 335 



no observed physical sign at first except exaggerated knee- 
jerks. He described endlessly ^'bearing-dozun pains, '''^ weak- 
ness, "gone feelings," feelings like "any one with delirium 
tremens," a "mock appetite,''^ disorders in bronchial tubes and 
mucous membranes, "incurable disease." Begged medicines, 
but would take them for a few days only, as "they would 
do no good." 

Emaciation and anaemia progressed. Fistulce about 
anus appeared, but the delusions were not leveled specifically 
at these. Later decubitus and loss of control of bladder and 
rectum developed. Death about seven years from onset, 
July 18, 1894. 

Death was due to general miliary tuberculosis, espe- 
cially shown in lungs and liver. 

Case VIII presents an interesting correlation of de- 
lusions with mitral stenosis. J. W. (D. S. H., 10746, Path. 
Lab. 944) is a Swedish servant girl who was admitted at 
thirty-eight, after about two years of doubtful symptoms. 
Patient was at first given the diagnosis chronic delusional 
insanity, which was later translated into dementia prcecox. 

There was an allopsychic content — sense of control by 
some one — in patient's delusions. " Stomach draws, and 
seems to close upT ''''Bones slightly bent^ Told later of a 
''sense of pressure on head^ Auditory hallucinations from 
time to time. Seven weeks after admission patient did 
**not feel the same," seemed to "get smaller every day," 
felt '^ stiff around the waist, as if her body belonged to some 
one else." "Knows that some one wishes to take her 
strength." 

A weak heart kept patient in bed. Suddenly a few 
nights before death patient complained of great epigastric 
distress; obviously an effect of the heart disease from which 
she died at forty years. 

The autopsy (Dr. A. M. Barrett) showed an interesting 
heart in which all valves, except the mitral, give measure- 
ments approximately Krause's mitral d.j; (Krause 10.4), 
tricuspid 12 (Krause 12), aortic 7.5 (Krause 7.7), pulmonary 
8.5 (Krause 8.9). The mitral valve also showed thickening, 
roughening, and a focus of erosion. Both auricles showed 
chronic endocarditis. Left and right ventricle walls both 



336 On the Somatic Sources of Somatic Delusions 

thickened (L. 1.5; R. 0.5). Heart somwehat hypertrophied 
(330 grams). Fatty heart. Coronary sclerosis. Double 
hydrothorax. Hypostatic pneumonia. Fatty liver with slight 
cirrhosis. Marked chronic diffuse nephritis. From the 
liver were cultivated pneumococci and a colon-like bacillus. 

The analysis of these cases is evidently difficult. We 
may incline to a somatogenic view, or we may conceive it a 
priori unlikely that the sensorium has much to do with such 
complex matters as these delusions. In this plight I shall 
adopt the device formerly employed (with Dr: J. G. Fitz- 
Gerald) of analyzing deliberately from both points of view. 

First, putting the best foot foremost for the somatogenic 
view, I may present the following brief: 

Analysis I (Somatogenic) 

Case I. Delusion: Shot with a seven-shooter in a 
place showing no wound but in which pain was felt. Lesion: 
Localized dry pleurisy over acute pneumonic process 
(remainder of pleural space on both sides obliterated). 

Case II. Delusions various, expressed in numerous 
hypochondriacal complaints and in a kneading of the right 
side of the chest and abdomen until they were black and 
blue. Lesion: Old adhesions of right pleura and hepatiza- 
tion of posterior part of whole right lung. 

Case III. Delusions: "My stomach is full, and I 
can't eat anything." Lesion: Intestinal obstruction by 
cancer. 

Case IV. Delusions: "Bees in the skull," "noises in 
the head." Lesion: Cranial osteomalacia, with fenestra- 
tion of one parietal bone. 

Case V. Delusions: "Left clavicle out of place," 
"fingers exchanged," "face a perfectly fitting mask." 
Legion: Osteopsathyrosis of ribs; chronic osteitis of inner 
table of occipital and parietal bones. 

Case VI. Delusions: "All ruptured"; persistent claim 
that bowels were dead, and refusal to eat. Lesion: Pul- 
monary phthisis, apparently quite synchronous with the 
melancholia. 

Case VII. Delusions: "Bearing-down pains" (patient 



E. E. Southard, M.D. 337 

male); "mock appetite"; trouble in bronchial tubes. Le- 
sions: Fistula in ano, general miliary tuberculosis (espe- 
cially lungs and liver). 

Case VIII. Delusions: "Stomach draws and seems 
to close up"; "stiff about the waist"; "bones slightly bent"; 
"pressure on head." Lesions: Mitral stenosis, mitral and 
auricular endocarditis. 

Now let us proceed to lay emphasis on other factors in 

Analysis II (Non-somatogenic) 

Case I. The delusion ^^shot with a seven-shooter''^ in a 
dement (or imbecile) some five years after onset of active 
mental symptoms is too fragmentary a phenomenon to be 
considered in correlation. In any event, patient may have 
felt a regionary "shooting" pain and, in a quite verbal way, 
attached this sensation to some sexual delusion of long 
standing. 

Case II. Many other delusions than the one possibly 
expressed by the over-vigorous kneading of the side were 
entertained by this patient. As patient's father was a sui- 
cide and brother insane, there is strong hereditary taint; it 
is dubious whether any of the hypochondriacal feelings shown 
are more than expressions of an "unstable brain." In any 
case the reaction of kneading the side may have been merely 
an exaggerated response to actual pleural impulses referred 
to the skin. Nor can it be shown that there is a time- 
relation between the pleuritis and the supposed-to-be-corre- 
lated massage. 

Case III. This oldish patient was for some time per- 
haps rather characterized by delusions of persecution than 
by the somatic delusions specified. It is also dubious 
whether the brain of this amnestic patient can be thought 
quite normal, and the statement, "my j-^om<^cA is full, and I 
can't eat,^^ may have been little more than a form of words to 
put off importunity. (Analysis of the cortex, in the light 
of this objection, does show a certain amount of satellitosis, 
particularly in the lower layers of temporal cortex, as well as 
other changes, and possibly the case should not be included 
in a pure series of "normal" brains.) 



338 On the Somatic Sources of Somatic Delusions 

Cases IV and V. It seems far-fetched to bring in soft 
bones in one case and fragile bones in another to correlate 
with delusions after all probably rather fleeting. We know 
too little of the way in which bone conditions are made 
known (if they are made known) to the central nervous 
system to attempt such correlations. Case IV was in any 
event a "phenomenal liar." 

Cases VI and VII are simply cases of mental disease 
complicated by tuberculosis. Hypochondria and tuber- 
culosis are both too common to make correlations of the sort 
attempted very convincing. Case VI is, perhaps, the weak- 
est attempt at correlation in the series. 

Case V^III. The variety of non-explained phenomena 
in this case of dementia prsecox is too great to make the 
mechanical hypothesis of cardiac conditions as a basis of 
certain delusions convincing. There is also a marked tinge 
of social delusion-formation in this patient. 

Summary 

The writer has sought a series of cases of delusion- 
formation in which the false beliefs were such as to impute 
structural disorder to various organs (somatic or visceral 
delusions). Since no collection of correlations, however 
striking, is conclusive in the face of hosts of other non- 
correlations assumed to exist, resort was had to a statistical 
method. In a series of one thousand autopsied cases, some 
thirty-eight cases having characteristic somatic delusions, 
and not showing obvious brain lesions at autopsy^ were found. 
Of these thirty-eight, eight were found which were fairly 
free, at least concerning the correlations at issue, from com- 
plications with delusions of other types (personal or social). 

In these eight cases thus impartially drawn, a statistical 
correlation can be safely stated to exist between such 
"somato-psychic" or severe "hypochondriacal" cases and 
serious somatic disease. It seems certain that these serious 
somatic conditions colored the lives of the patients. 

In one group of cases (Cases 1, II, III, possibly VIII) 
the psychic rendering of the somatic states is rather critical 
and temporary, and^ follows a process somewhat compre- 



E. E. Southard, M.D. 339 

hensible to the normal mind. (Type: ^'shot by a fellow with 
a seven-shooter,'''' in a spot found to correspond with a patch 
of dry pleurisy.) 

In others (Cases IV, V) the psychic rendering is less 
natural and is more a genuine transformation of the sen- 
sorial data into ideas quite new. (Type: ^'bees in the skulV 
found in the case with cranial osteomalacia.) 

In others (Cases \T and VII) the problem is raised 
whether severe hypochondria, with ideas concerning dead 
entrails and the like, may not often indicate such severe 
somatic disease as tuberculosis. The psychic rendering here 
is of a more general (apperceptive.'^) sort. 

Hereditary predispositions, acquired dispositions, and 
manifold unexplained correlations must be clearly admitted. 
The concept of the crystallization of delusions around sensorial 
data of an abnormal sort must be entertained for some cases 
at least. It would not be safe to neglect these somatic data 
any more than it would be well to neglect the patient's 
turn of mind, his critical (though perhaps forgotten) emo- 
tional past experiences, or his ancestry. It might prove 
that the results of careful physical examination would have 
much to do with the diagnosis, or even the prophylaxis, of 
certain delusional conditions. 



PSYCHOANALYSIS AND SOCIETY 

BY TRIGANT BURROW, M.D., PH.D. 

ALL great scientific theories sooner or later filter 
through to the masses of mankind, modifying their 
opinions, altering their conduct, shaping their lives. 
It has been so with the theory of evolution through- 
out all its implications upon the side of organic variation and 
development; it will be so with this theory as regards the 
aspect of evolution that concerns itself with the modification 
and growth we call functional. For the lineal, develop- 
mental, historical point of view of evolution is common 
to the psychological as well as to the morphological sphere 
of biology. In the latter the mind of man is reflected upon 
his own structure. He looks back upon the course of his 
organic development and presumes to study his physical 
descent. In the study of genetic psychology mind becomes 
reflected upon its very self and man makes bold to discover 
the origin of his soul and to reconstruct from genetic sources 
the components of his own ego. Thus the genetic position 
applies equally to psychology as to morphology and the 
method of biology becomes throughout supreme. Ac- 
cordingly there is no element of experience, whether mental 
or non-mental, but may be submitted to biological analysis. 
The psychoanalyst, therefore, who is a consistent stu- 
dent of mental life is not less committed to the genetic view- 
point in his study of the factors entering into the determina- 
tion of the modifications and reactions we call mental, than 
is the student concerned with the analysis of phenomena 
occurring within other spheres of biology. Accordingly, 
man is as much the product of evolution in respect to his 
mental as to his anatomical make-up. For the psychic, no 
less than the physical organism is subject to inevitable 
genetic laws and mental phenomena stand in rigid conformity 
to evolutionary principles which it is the task of psycho- 
analysis to retrace. 

Virtually, psychoanalysis, being the application of 
Darwinism to the psychic sphere, represents essentially the 
obverse of organic evolution. As its concern is with biology 

340 



Trigant Burrow, M.D., Ph.D. 341 

in its functional aspect, psychoanalysis is but the extension 
of biology into the realm of consciousness; so that in ex- 
plaining mental phenomena it invokes the same principles 
to which biology is throughout committed. For in the re- 
gressions of function characteristic of the neuroses we recog- 
nize an analogy to the retardations of development occurring 
in the organic world. As in these organic involutions of type 
there are presented the rudiments of an ontogenetic and a 
phylogenetic process, so in the homologous psychic regres- 
sions there is instanced a reversion to a remote, primitive, 
biological mechanism appearing originally in ethnic as well 
as in individual development. 

Darwin ascribed various emotional reactions to a primi- 
tive, instinctive mechanism tending toward the amelioration 
and the preservation of the individual, such as the defensive 
reaction of pallor and other vasomotor reactions subserving 
the purposes of emotional escapement; similarly Freud con- 
verts the phenomena of hysteria and allied states into 
biological terms and reconstructs its symptoms upon the 
basis of primitive, defensive mechanisms inherent in the race. 

The distinctive feature of psychoanalysis then is its 
revival of apparently extinct trends, such as constitute a 
common ethnic possession and have their seat in the mental 
protoplasm, so to speak, which we describe as "the uncon- 
scious." Thus the unconscious is the repository of an ob- 
solete past, the reliquary of an early, archaic existence. For 
there reside in the unconscious the propitiatory superstitions 
of savagery; the teleological mechanisms of hallucination and 
projection in which are based the religions and mythologies of 
the race. It is in the unconscious that the neurotic enacts the 
secondary role into which he withdraws from the scenes of 
actuality, and it is here that the harassed mind indulges the 
delusions through which it abates the poignancy of reality 
and escapes into the fantastic world of the psychoses. 

Such a biological interpretation of mind as is necessitated 
by the analytical method is fraught with far-reaching signifi- 
cance to society. For in thus reducing to their ultimate, ge- 
netic components these various manifestations of the human 
soul, with its deepest aspirations, its tenderest yearnings, 
its most sacred affections, we are destroying the springs of 



342 Psychoanalysis and Society 

those primitive sentiments which have actuated all that is 
best in human conduct. For psychoanalysis is subversive 
of those forms of religious belief upon which society is 
founded and in which it subsists, annihilating the conven- 
tional incentives so strong in the life of man to-day. Beliefs 
which the world has held most sacred are reduced to the 
level of "psychological mechanisms," and are ranged upon a 
common ground with other biological phenomena. The 
conception of creation is such a mechanism, having its 
ontogenetic counterpart in the familiar, distorted birth- 
fantasies characteristic of childhood. In the light of psycho- 
analysis the narrative of the Book of Genesis shows strongly 
the influence of the inevitable incest conflict. The concep- 
tion of a Heavenly Father becomes an unconscious "pro- 
jection" mechanism whereby the childhood of the race seeks 
to perpetuate its human progenitor. The heaven of tradi- 
tion is but an unconscious wish-fulfillment representing the 
early dream symbolism of primitive man. The triune per- 
sonality of the Deity traces its source to an unconscious 
sexual symbolization. Again and again throughout religion 
and mythology we meet representations which in the light 
of mental evolution are to be interpreted as residues of the 
same symbolic impulses that led to the ancient phallic 
worship. Thus the traditional beliefs in which man is 
sustained to-day become mere recrudescences of unconscious 
mechanisms originating in the infancy of the race — mere 
survivals in the process of man's psychic descent, traceable 
in every instance to the dynamic instinct of perpetuation. 
While psychoanalysis has no bearing upon the realities 
underlying the symbols of religion, yet the above considera- 
tions have unhappily led to the conclusion that philosoph- 
ically psychoanalysis becomes a name for the utter abroga- 
tion of religion and the apotheosis of sex.^ 

^ Since psychoanalysis is concerned with the biology of the instinctive, in- 
fantile, organic mental processes generically subsumed under the rather ineptly 
named category of "the unconscious," and with the bearing of these dynamic im- 
pulses of the primal mind upon prevailing sociological tenets, the present paper is 
logically as innocent of complicity in questions of philosophy, metaphysics, or re- 
ligion as, let us say, a dissertation on the photochemic reaction of amcebae. 
There is, however, in the present discussion, because of its formal juxtaposition 



Trigant Burrow, M.D., Ph.D. 343 

Parallel to these social implications there are the analo- 
gous deductions in respect to the individual. For since 
psychoanalysis interprets neurotic disorders as consisting 
solely in the distortion of the psychic demands of sex into 
symbolic equivalents through the patient's repudiation of 
this primal instinct, it is but natural to expect that the logical 
therapeutic procedure in these conditions lies in reconverting 
such fruitless substitutes into their original trend through 
recourse to sexual indulgence. One would expect that con- 
ditions due to blockingof an outlet were to be relieved through 
clearing the outlet. But we need distinguish very carefully 
between the aspect of sexuality that is somatic and that 
which is psychic and clearly recognize that the affections 
which come within the province of psychoanalysis are es- 
sentially psychological disharmonies, and that their treat- 
ment depends therefore upon resort to psychological and 
not to somatic agencies. Else, were normal sexual indul- 
gence the panacea for neurotic disorders, how are we to 
account for the existence of a neurosis in individuals in- 
dulging regularly in the sexual relation.^ How are we to 
reconcile the presence of a neurosis in patients who in their 
sexual lives are veritable Don Juans.^ There appears to be 
some discrepancy here, for evidently in these cases indul- 
gence fails to meet the demand. Therefore, it seems to me 
highly pertinent to inquire how far, if at all, the certificate 
of indulgence is essential to the psychic health of the neu- 
rotic and to view the social and moral aspects of the situa- 
tion confronting us in this connection. 

with these domains, at least an implicit likelihood of misconstruction, which it 
were, perhaps, wise to avoid. 

Let it be said then that the writer would on no account wish to be understood 
as failing to distinguish between abstract philosophical truth per se and the con- 
crete, form in which such truth finds its pictorial embodiment. Such a method of 
reasoning were indeed a gross philosophical fallacy. While psychoanalysis shatters 
the image, it leaves unimpaired the essentia whereby it is animated. Though it 
efface the symbol, there remains the reality discernible behind it. 

Let it be remembered then that psychoanalysis is concerned alone with the 
lower mental forms presented in the instinctive reactions we call unconscious, while 
on the contrary the concern of philosophy is precisely with the later psychic modes 
expressed in the higher intellectual processes we call conscious, and that at no point 
do the two spheres unite. 



344 Psychoanalysis and Society 

Now that psychopathology is outgrowing the dark age 
of neurological superstitions it recognizes that there is a 
psychology as well as an anatomy of disease. We now know 
that psychic disorders are not essentially neural, but moral; 
that these conditions reside not in the cortex, but in the 
conscience. In other words, the morbid process confronting 
us is essentially a disease of the totality we call the soul; con- 
sisting of divided elements at war with one another, the one 
trend autoerotic, infantile, egoistic, unconscious; the other 
moral, social, altruistic, conscious. 

In a formal way at least psychopathology has always 
recognized this inherent opposition in the psychic life of 
the nervous invalid. It has also recognized the possibility of 
converting the more confined, individual trend into the 
broader social outlet of collective interests and of group 
activities generally. 

This transformation of primary, unconscious trends into 
maturer, more intellectualized conscious expression, a pro- 
cess of which Ernest Jones has recently given us a most in- 
genious account, is one of the most important chapters of 
Freud's psychology. Among the collected essays of the 
"Neurosenlehre" there is one in which he speaks of the 
definite correlation between certain infantile, sexual trends 
and the characterological traits into which these trends 
issue in the process of sublimation, and he has elsewhere 
discussed the pedagogic import of this relation in determining 
the appropriate direction of sublimation in a given individ- 
ual.^ The sublimations afforded in general through artistic 
pursuits are only too familiar to us all. How adequately the 
sexual instinct may be sublimated through the religious 
life is also a matter of common observation, society having 
attested its recognition of the complementary positions of 
religion and sexuality in its injunction of celebacy upon the 
priesthood. 

Now as the nature of a neurosis is a moral conflict in 
which the patient is torn between the contrary impulses of 
right and wrong, that is, of reason and instinct, and as 
through recourse to repression and substitution such an 
individual has resolutely declared in favor of the latter, that 

^Recent observations -of Brill's tend to add corroboration of Freud's view. 



Trigant Burrow, M.D., Ph.D. 345 

is of loyalty to self-imposed command and resistance to the 
gratification of self, does it not follow that the appropriate 
avenue of sublimation for the neurotic in general lies in the 
direction of renunciation, of character, of the moral ideal? 
In other words, does it not seem that the logical sublimation 
for unconscious repression is conscious control? 

Every psychopathologist witnesses daily the character- 
istic conscientiousness of the neurotic patient — his fidelity 
to purpose, his devout conviction of duty, his deep, respect- 
ful sense of his obligations. The neurotic individual is 
essentially a moral individual and the neurosis which repre- 
sents the struggle of the higher self of reason and will against 
the lesser self of instinct and brutality is thus the very es- 
sence of character-building. For character is respect for 
the permanent, the ulterior, and the social as opposed to the 
immediate, the limited, and the personal. In a word, it is 
loyalty to the social ideal. Though psychoanalysis may 
show this ideal to be of very humble biological origin, though 
it be proven the mere reaction to repressed sexual fixation, 
it is the ideal still, and as such presupposes the sacrifice of 
the invididual to the larger social weal. 

The question is then, shall psychoanalysis seek to cure 
the neurosis through the shattering of the social ideal? Are 
we to say to the men and women who are made aware through 
analysis of the sexual complexes underlying their onerous 
ideals, "Let your ideals go! Ideals are fantastic, neurotic. 
Obey your instincts and so be at unity with yourself?" 
Well, it is one way of deciding the issue. But it is the way 
of mediocrity and concession. It is the selfish, personal, 
and impermanent way, not the way that looks to the larger 
social interest. 

The men from whom the world has drawn its inspiration 
have always been characterized for their devotion to the 
social ideal; they have been men who have ever scorned 
to accept personal comfort at the detriment of the body 
social, who have ever refused whatever advantage was not 
attainable upon high, honorable terms. It is such men who 
by their conduct have elevated biology to a conscious, social 
level, who have raised the plane of society and improved the 
condition of the race. 



346 Psychoanalysis and Society 

The conflict embodied in the neurosis is one which will 
continue while life lasts, for the infantile, instinctive demand 
is ever present and insatiate; but while admitting its im- 
portunities into consciousness and even into conduct if 
medically the need be, it seems to me the duty of the psycho- 
analyst to recognize and to take sides with the splendid power 
of resistance, so strong in the neurotic, against life's cruder 
demands, and by converting it into a conscious, open, rea- 
sonable resource to assist him in the attainment of a higher 
manhood. He does not silence the lesser, instinctive need, 
but at least he is contributing to the production of a higher, 
more conscious type. 

Perhaps from the viewpoint of therapeusis alone the 
attitude here taken is not the most immediately rewarding, 
but my position is that psychoanalysis is responsible not 
alone to the individual but to society as well, that it has to 
take cognizance of the civil as well as of the personal issues 
entailed. 

It seems to me therefore that to seek to remove un- 
conscious repression through the sublimation afforded in 
conscious control is not only logical, but is ethically the only 
attitude for the psychoanalyst who is fully sensible of the deep 
social significance presented in the drama of the neurosis. 

I trust that my attitude will not be construed as an 
overture to the sentimentalizing spiritual adviser or mental 
healer. Contrary to such a concession, it is here main- 
tained that as ethical principles are genetically but the subli- 
mated reactions to factors which are ultimately biological, 
these broader social and ethical issues are as essentially the 
problem of the psychopathologist as the more immediate non- 
mental factors to which tradition has hitherto restricted him, 
•and that, therefore, the condition of society is most to be as- 
sisted when its obligations to psychopathology are most 
fully recognized. 



A NOTE ON THE COLOR SENSE IN RELATION TO 
THE EMOTION OF SEX 

BY GEORGE HENRY TAYLOR, L.R.C.P.S., SYDNEY, N.S.W. 

A PERCENTAGE of human beings and birds have in 
common an inherited emotional factor which finds 
its expression in musical sounds. In bird life the 
musician is a male, excepting the rare case where a 
caged female bird exhibits the emotion of song. The in- 
herited emotion in each variety of singing bird is ex- 
pressed in a sequence of notes peculiar to itself, although 
the quality of note may vary a little in different birds. 
By the selective breeding of caged birds the quality of 
note can be improved. For example, by mating finches 
of different varieties, the offspring acquire a song which 
is a blend of the notes in the song of the male bird in 
each variety. Such birds are not fertile. No doubt the 
female bird admires with a keen appreciation the color 
or song of her mate, but it is doubtful whether the color or 
song of a male bird is a delight to others of his sex. A bird 
in a cage when singing appears to be in a state of rapture, 
and does not then give an observer the suggestion of intel- 
ligence as it does when with head aslant it is alert and ob- 
servant. 

The period of sexual activity in singing birds alternates 
with a longer period of sexual calm, when male and female 
are associated in what is practically an asexual state. The 
sex song, therefore, of a singing bird is an emotional ex- 
pression on the part of the male, sung under similar condi- 
tions season after season. There is an absence of the per- 
sistent sex-brooding of the human male and female, which 
extends throughout the sexual period of their life. The 
environment of the bird may change, but so slowly that it 
is practically the same year after year. The environment 
of the human unit, on thq other hand, is comparatively un- 
stable. The human male also appeals to the female through 
the emotions of song and color, though he is more promis- 
cuous in his loves than is the singing bird. The non-creative 
musical male interprets the appeal of musical sounds ac- 
cording to his degree of emotional appreciation and ex- 
pression. 

347 



348 Color Sense in Relation to the Emotion of Sex 

The development of mind in human beings places male 
and female frequently on the same intellectual plane, and 
association on that plane may simulate a feminine element 
in the male, or a male element in the female, and occasionally 
the latter creates new manifestations of emotion in color 
and music. But as a rule the female is appreciative of the 
emotion of music, and not creative of music itself. It is 
further to be noted that in birds color and music are usually 
apart. The bird of brilliant plumage is nearly always song- 
less, whilst the smaller singing bird is more frequently as- 
sociated with somber feathers. The description I have 
given in former notes of the expression of emotion in a color- 
blind person, shown in his face and voice, was drawn from 
an extensive experience of men, who, from a color and mu- 
sical standard, might be termed primitive persons. A much 
less extensive experience apart from this class suggests to 
me that when a person is blind to red and green, and also 
indifferent to musical sounds, the condition I then described 
in regard to the voice is accentuated. I infer, therefore, 
that when a person with a keen appreciation of musical 
sounds is blind to red and green there still may be a degree 
of color recognition through sound. When a person blind 
to red and green is in contrast to a person with a keen color 
sense, immediately prior to examination by Holmgren's 
Wools, the condition common to each mind is a degree of 
expectancy. The face and attitude of the red green blind 
is suggestive of a person who is listening; the face and atti- 
tude in the other, of a person who is watching. 

In my small experience of musicians, I recognize two 
types: a color type which is bright and joyous, to instance 
Mozart, and a type which is introspective and gloomy with 
a comparative indifference to external objects, of which 
Beethoven may be taken as an example. 



PROCEEDINGS OF THE AMERICAN PSYCHO- 
PATHOLOGICAL ASSOCIATION, MAY 29, 1912 

{Continued) 

AFTERNOON SESSION 

THE meeting was called to order at 3 p.m. by the 
President, Dr. Adolf Meyer. 
Dr. Tom A. Williams, Washington, D. C, 
read a paper entitled "Juvenile Psychogenetic 
Disorders: Pathogenesis: Treatment." 

Discussion 

Dr. Ernest Jones, Toronto : I would ask Dr. Williams 
how he explains the visions of these wild animals, snakes, 
etc., in the last case he reported. 

Dr. James J. Putnam, Boston: I should like to ask 
Dr. Williams to say a few words more about his last remark. 
I understood him to say that he could not get at all the ex- 
periences in his patient's case, and that they were unim- 
portant. I only wish to say that I think that these experi- 
ences of very early childhood are of the utmost importance, 
because, on the one hand, they are of a sort that most 
people have been in the habit of paying little attention to; and 
yet, on the other hand, they establish paths of least resist- 
ance which the subsequent development is likely to follow. 

Dr. Tom A. Williams, Washington, D. C. : It was not 
my intention to take a controversial attitude of the whole 
method of the fundamental basis of genesis of psychie 
disorders in children. I merely wished to point out some 
which seemed efficient in particular cases. I do not feel in 
sympathy with the attitude which assumes the relation of 
the child to his parents to be very important. It seems to 
me that in children there may be a recurrence to the recol- 
lection of affective experiences which have eventuated from 
dreams. The fact that this happens with everybody seems 
to somewhat invalidate the hypothesis that assumes them 
as the parent cause. With regard to what Dr. Jones has 
said, it was not possible in the half hour to endeavor to 
explain why this child did see particular animals. 

Dr. G. Alexander Young, Omaha, Neb., read a paper 

349 



350 The Journal of Abnormal Psychology 

entitled "Report of a Case of Versuchung Angst Attended 
by Visual Hallucinations of Homicidal Nature; Psycho- 
analysis." 

No discussion. 

Dr. Trigant Burrow of Boston read a paper entitled 
"Psychoanalysis and Society." 

Discussion 

Dr. James J. Putnam, Boston: I like the general 
trend of Dr. Burrow's argument so well that I should like 
to say a few words that may seem critical, though they 
are not intended to be such. What I would say should be 
considered as a supplement to his views rather than antag- 
onistic to them. It seems to me that psychoanalysis is to 
be regarded as more or less on a par with the natural sciences, 
and, being on a par with the natural sciences, it does a cer- 
tain work and no more. The physicist deals in certain 
constructions which he assumes and through which he is 
enabled to get at certain working theories which are of 
great value. The biologic evolutionist does no less. He 
takes an arbritrarily cut-off portion of evolution and as- 
sumes that in studying that he goes back to the beginning 
and passes from the simplest conditions to the more com- 
plex. In fact, however, I think he really does not go back 
to the simplest form of the problem. He leaves the question 
of the origin of the instincts, which we assume to be so 
primarily really untouched, and what we really need and 
should study as a supplement to psychoanalysis is phi- 
losophy in one form or another. 

When we make any mental effort to recognize the in- 
finitude of the mental capacity on one hand, and the finite- 
ness of any definite expression on the other hand, and in 
doing that we really discover the first contrast in the struggle 
of life, and one which is logically anterior to the contrast 
which we discover through psychoanalysis. The neurotic 
patient feels that there is conflict in his own mind. It 
literally turns upon itself. As far as the matter of the re- 
ligious question goes, I would not undertake here to touch 
on that subject at length. I entirely admit that the ordi- 
nary religious idea of God gets its color and form from the 



Discussion 351 

projection of an earthly father; I do not, however, believe 
that it gets its first origin in that way. That is to say, 
the mind, in dealing with itself, is conscious of its own re- 
lation to the source of power which one may decline en- 
tirely to define, but which is logically the. basis of our notion 
of divinity and motivates the desire to project the existence 
of an earthly father. So, too, in regard to the Trinity idea; 
I agree with the conception of the Trinity. It must also 
not be forgotten that there is a Trinity antecedent to that, 
namely, the mind recognizing itself as subject and object; 
and as lying down to relation between self anf object con- 
stitutes something which is present in every mental act, I 
do not think that we can very fairly assert that psycho- 
analysis strikes at the real origin of mental action until we 
really seriously look into the origin of life from that point 
of view. We do not come a single scrap nearer the origin 
of life by beginning with the child or with the germ or the 
egg. The question is, how did they come to be there .^ 
Then we come to a self-active force which is just as incapable 
of growth as electricity is, and find that we must account for 
that, and that, in a certain sense, we can account for it. 

Dr. Ernest Jones, Toronto: Dr. Prince is incorrect 
in attributing to psychoanalysts the view that symbolisms 
are inherited. I should, perhaps, rather speak for myself, 
and say that I personally do not hold that view, though as a 
matter of fact I do not know any other psychoanalysts 
that hold it. It seems to me to be untenable on the ground 
that it would contradict the well-known biological law as 
to the non-transmissibility of acquired characters. The in- 
ference that psychoanalysts draw from the important 
finding that identical symbolisms occur unconsciously in 
the neuroses and consciously in more primitive races is a 
quite different one. Holding as we do that unconscious 
symbolisms are essentially of infantile origin, we consider it 
a valuable confirmation of the truth of our views when we 
find that identical symbolisms occur in the childhood of the 
race, here not being repressed into the unconscious, but 
remaining conscious throughout adult life. 

Dr. Trigant Burrow, Baltimore, Md.: The reply 
which Dr. Jones has made to Dr. Prince's objection that 



352 The Journal of Abnormal Psychology 

racial trends may not be inherited by the individual seems 
to me a sufficient answer. In pointing out the observed 
analogy between unconscious mechanisms existing in the 
individual and those inherent in the race I no more wish to 
adopt the view, ia regard to the functional side, that the 
mental traits of the individual are of the nature of an in- 
heritance from the homologous mental characters of the 
race than, in respect to the organic realm, I should pretend 
to espouse the view that the parallelism observed between 
the lineal phases of development in the phylogenetic and 
in the ontogenetic series could in any sense be regarded in 
the light of an hereditary descent. But just as organic or 
structural biology cites the progressive correspondence 
between the individual and the ethnic spheres of develop- 
ment in support of the evolutionary hypothesis of organic 
forms, so it seems fitting that functional or mental biology 
point to the analogous concurrence, in respect to the psychic 
side, in corroboration of the genetic hypothesis of mental 
modes and mechanisms. 

The parallelistic notion of concomitance is surely to 
be sharply discriminated from the causal conception con- 
tained in the derivative idea of heredity. 

In regard to Dr. Putnam's remarks I may say that I 
am wholly at one with him in the philosophical position 
for which he contends. In all that I have said, however, 
I find nothing in the least inconsistent with the philosophical 
views expressed by Dr. Putnam. Philosophy has to do with 
conscious deductions, while psychoanalysis is concerned 
exclusively with the phenomena of unconscious mentation. 
So that while analysis invalidates the symbols expressive 
of the archaic forms of religion, it does not encroach for a 
moment upon the question of the realities underlying them . 

Dr. Isadore H. Coriat of Boston read a paper entitled 
"The CEdipus-complex in the Psychoneuroses." 

Discussion 

Dr. Brill, New York: I agree with most of the state- 
ments made by Dr. Coriat, but I would like to correct the 
assertion that only children who are predisposed to psy- 
choneuroses usually show an exuberant love for the mother, 



Discussion 353 

the CEdipus-complex. I must say that I have found the 
CEdipus-complex in just as many normals as in neurotics. 
In fact it is found in every individual, but whereas in the 
normal person it remains in a state of repression, the neu- 
rotic shows its influence on the surface and can never tear 
himself away from his parental influences. This parental 
influence is found in every individual, indeed our relations 
to our fellow-beings depend entirely on it. The first im- 
pression of a man is formed by one's father, and the first 
impression of a woman by one's mother. These father and 
mother images remain as a standard for our future estima- 
tion of men and women. We either like or dislike, depending 
upon how the person in question fits into the particular 
parental image. To be sure parents help to keep alive these 
feelings by giving the child too much love, as in the case 
mentioned by Dr. Coriat. When this happens the person 
may remain consciously attached to the parent. The 
CEdipus-dreams may be vague and symbolic, but some are 
quite plain. 

Dr. Alfred Reginald Allen, Philadelphia: I am in 
entire accord with Dr. Brill that this is a very common, 
if not always present, complex of early life, and I think we 
find a residuum of the CEdipus, or rather its Abwehr, in the 
symptom shown by the young boy, say from seven to 
fourteen years of age, who wants to play with other boys, 
being ashamed of playing with little girls. What has 
happened to him is that he has repressed his love for his 
mother and he has symbolized all women with his mother, 
and they are abhorrent to him. I had a case, referred to me 
some time ago, of alcoholic excess. The patient has been 
the rounds of many neurologists and had been treated for 
this difficulty by other means than psychoanalysis. 

I found by analysis that there was a very strong CEdipus- 
complex. I unearthed the fact that at four years of age 
the boy had watched his father in considerable danger of 
losing his life, with a feeling of interest, almost pleasure, 
but absolutely no feeling of regret whatsoever. Shortly 
after that we find him playing altogether with boys, es- 
chewing girls, then we find the homo-sexuality appear, 
which homo-sexuality is kept up until the present. Al- 



354 The Journal of Abnormal Psychology 

though I have many months' more work to do on the case 
I think in all probability his dipsomanic attacks are of the 
nature of pseudo-abreactions to repressed homo-sexuality. 

Dr. Ralph Reed: I had one case in which the 
tendency of the mother to give an over-affection was very 
marked, except that it resulted in a neurosis in an unexpected 
direction. The man came to me to complain of a psychic 
disorder. I found the mother had slept with the son from 
the time the child was born, the son being at that time 
twenty years old. The mother had banished the husband 
from her bed, sleeping entirely with the son. The conse- 
quence of that was that the mother secured such a dominance 
over the husband that she assumed for the son a masculine 
role and he developed a psychic disorder. 

Dr. Ernest Jqnes, Toronto, Canada: I should like 
to ask what relation Dr. Coriat has found in his cases be- 
tween this complex and the symptoms the patients were 
suffering from. 

Dr. I. H. Coriat: In all the material analyzed 
I found that the symptoms of the psychoneurosis reap- 
peared late in life. All phobias were symptoms of repressed 
incest trend, or in most cases reactions of defense against 
these ideas. The CEdipus-complex appeared only in those 
patients who were exposed to an over-exuberant love from 
their elders. 

D.r. L. Pierce Clark, New York City, presented a paper 
entitled "Remarks on Psycho-Genetic Convulsions and 
Genuine Epilepsy." 

Discussion 

Dr. Ernest Jones, Toronto: I should like to compli- 
ment Dr. Clark on his remarkably interesting paper. There 
is hardly any more important problem of the present day 
than the differentiation between true epilepsy and the vari- 
ous allied disorders. We seem to be reaching the position 
that the majority of cases diagnosed as epilepsy are of an 
organic nature. There are certainly, however, cases of 
psychogenetic convulsions that are absolutely indistinguish- 
able from the true epileptic fit, a fact which has been known 
for many years, though the truth of it is even yet denied 



Discussion 355 

by some neurologists. It is, therefore, a safe rule to go 
by that one should never make the diagnosis of epilepsy 
unless there are other evidences of the disease, notably 
character changes, apart from the fits. As I described in 
a paper two years ago, one can, by means of finer methods 
of observation, particularly by the word-association reac- 
tion method, find definite indications of these character 
changes long before there is evident mental deterioration. 
Even in regard to the genuine cases themselves, however, 
Maeder's studies have shown that much light can be thrown 
on the psychology of these patients by means of psycho- 
analytic investigations, and in a way that no anatomical 
study can ever be expected to; the changes in the cortex 
throw no light whatever on the character changes and other 
mental features of the disease. Maeder has in a very 
happy way endeavored to formulate a general expression 
for the basic biological changes, and has in so doing explained 
in great detail most of the symptoms. So that even in 
genuine epilepsy we are encouraged to continue our study 
of the cases from the mental point of view. 

Dr. Morton Prince, Boston: I wonder whether 
many here have seen those very interestong biographical 
pictures made of epileptics in their attacks, by Dr. Chase, 
many years ago. They were very striking. He made 
moving pictures of patients in fits. A very striking point 
that they brought out was the entire lack of any type to the 
epileptic fit. I remember a distinguished English alienist, 
who was present, would not believe that epileptic fits did 
not happen as classically described. He had seen thousands 
of cases, he said, and "ought to know." After he had seen 
these pictures he had to admit that he did not know what 
an epileptic fit was. There were scarcely two alike. From 
what we saw in those pictures we might almost say that there 
is no typical epipeltic fit at all. In taking my histories 
I have often required the patient's relatives to carefully 
observe and analyze a fit and report to me. I was early 
impressed with the variance between their reports and the 
descriptions of text-books. I felt that these observations 
were free from preconceived perceptions: that nothing was 
read into the fit. These reports early led me to doubt 



356 The Journal of Abnormal Psychology 

the classical descriptions as given in text-books, and I 
believe they more clearly corresponded with the later 
biographical pictures. 

I would like to ask Dr. Clark whether he does not 
think that aid in the differential diagnosis, which has some- 
times bothered me, may not be obtained by inquiring 
whether there were such psychical symptoms as phobias, 
fixed ideas, and so on, present. If present they would cast 
suspicion, at least, upon the epileptic fit. I would lay 
weight on those symptoms as a guide to the character of the 
fit in doubtful cases. Of course epilepsy may complicate 
the psychasthenic condition. 

Dr. I. H. CoRiAT, Boston: I would like Dr. Clark 
to put in a few facts how clinically to distinguish between 
psycho-epilepsy and genuine epilepsy, particularly if the 
attack is general and not limited. 

Dr. Brill, New York: I had some experience in 
analyzing cases of so-called genuine epilepsy. I recall one 
remarkable case that has been diagnosed and treated for 
nine years as a case of genuine epilepsy. When the woman 
came under my observation she had a few attacks daily in 
spite of consuming very large doses of bromide. I soon 
became doubtful as to the diagnosis, and concluding that 
it was a case of hysteria I analyzed her for about nine 
months with very good success. It is now two and a half 
years since I have discharged her and she had no recurrent 
attacks. I hesitate to report this case as cured, although 
the analysis appeared complete and the result would seem 
to warrant it, because experience teaches that even genuine 
cases of epilepsy sometimes stop for a few years only to 
return again. But there is no doubt that the psychogenetic 
factors play a part in even the genuine epilepsies. Thus I 
recall an epileptic with pre-epileptic episodes in my service 
in the psychiatrical clinic at Zurich, who was to be sent home 
for a visit at the Christmas vacation, when he began with 
one of his episodes. He was told that unless he stopped he 
would have to forego the visit. He stopped the episode 
and was sent home, but as soon as he returned he merged 
into his usual attack. Such cases would lead one to think 
that it is worth looking into the psychogenetic factors of all 
cases of epilepsy. 



Discussion 357 

Dr. Ernest Jones, Toronto: Dr. Hughlings Jackson 
said to me the last time I saw him, "If you think of taking 
up the study of epilepsy follow this advice, start all over 
again at the beginning and study the individual attacks 
you see without any preconceived notions." In reviewing 
the opinions held ten years ago with those of to-day his 
advice seems good. 

Dr. Adolf Meyer, Baltimore, Md. : I am somewhat 
impressed by the optimistic attitude shown in the facts 
communicated when I compare these utterances with those 
of Dr. Ulrich, with whom Maeder did part of his psycho- 
analyses. Ulrich was distinctly under the impression that 
in cases of epilepsy psychoanalysis had not made any 
headway from the point of view of therapeutics. It is an 
extremely difficult problem because somehow the epileptic 
undoubtedly shows a liability to fluctuations which are 
bound to show in the disease curve — as, for instance, the 
effect of any novel or startling treatment which very often 
reduces the frequency of attacks in an institution for a time 
in a marvelous fashion. I mention the somewhat negative 
statement of Ulrich in order to encourage the publication of 
careful and explicit and full accounts of any cases in which 
claims of beneficial results are being made. In regard to 
hypnosis we also know of favorable results, but the criticism 
regarding this has been exactly the same, that epilepsy 
is an extremely variable disorder, and observation for long 
periods usually reduces the optimism to a fairly low level. 
For the demonstration of favorable effects by psychoanalysis 
it will be very important to give full accounts, and I should 
not shirk from the appearance of too great length if it is 
necessary to carry conviction. Moreover unless in such a 
series the cases are again controlled and reported upon five 
or ten years after the first report the author should be 
criticised for lack of scientific conscience. The lack of 
obligatory revisions and of completion of the published 
casuistic material deserves the severest criticism as a most 
deplorable defect of our scientific practice in psychiatry and 
psychopathology. 

Dr. L. Pierce Clark, New York City: I am glad to 
note that most of the speakers present recognize that the 



358 The Journal of Abnormal Psychology 

differential diagnosis of convulsive phenomena must rest 
in greater part upon the so-called collateral symptoms pres- 
ent in a given case, and not upon the seizures themselves. 
If the seizures of epilepsy differ ever so little from the main 
symptoms of a so-called classic attack I look upon the 
diagnosis with suspicion until thoroughly observed. Psy- 
choanalysis will invariably assist us in clearing up psycho- 
genically produced symptoms in the fit, but will give no 
aid as far as the genuine disorder is concerned, as that is 
conditioned upon anatomic grounds. Undoubtedly incon- 
tinence of urine and tongue biting are the most pathognomic 
of epilepsy in differentiating it from seizures psychogenically 
produced. I have had a case under my observation for 
over three years in which there was tongue biting and pas- 
sage of urine in attacks, and yet the disorder proved to be a 
psychoneurosis, and has been cured by psychoanalysis. 
She has had no symptoms for more than two and a half 
years. She has taken no sedatives. The case did not have the 
voice sign, the circumstantiality of speech, the abrupt phrase 
rhythm in conversation (sausage link conversation), memory 
defect, nor disposition of the epileptic make-up. The 
absence of all these collateral signs and symptoms in the 
make-up caused me to doubt the epilepsy diagnosis with the 
above result. I agree with Dr. Meyer in opposition to Dr. 
Brill, that the uncomplicated genuine disorder of epilepsy 
is little if at all modified by psychoanalysis so far as the 
convulsion phenomena itself is concerned. Regarding the 
curability of the genuine disorder, I published twenty-nine 
cases of cure or arrest, and hoping to find case material 
for at least one hundred epileptics for study, I was dis- 
appointed, as there were not a half dozen on record worthy 
of analysis. There were plenty of statements of per cents, 
but no actual case histories to substantiate them. 

Adjourned 5.12 p.m. 



ABSTRACTS 

UNTERSUCHUNGEN UEBER DIE KONSTANZ UND DEN WECHSEL 
DER PSYCHOLOGISCHEN KONSTELLATION BEI NORMALEN UND 
FRUHDEMENTEN (sCHIZOPHRENEN). (INVESTIGATION OF THE 
CHANGE AND CONSTANCY OF THE PSYCHOLOGICAL CONSTELLATION 
IN NORMAL INDIVIDUALS AND IN EARLY DEMENTS (sCHIZOPHREN- 

ics).) Von W. Pfenninger. Jahrbuch fur psychoanalytische 

UND PSYCHOPATHOLOGISCHE FORSCHUNGEN, Bd. Ill, 2d Half. 

1912. 

Various observers in working with association experiments 
have noticed that certain stimulus words cause a lengthening of 
the reaction time, and that when the experiments have been 
repeated at varying intervals of time the same prolongation of the 
reaction time is present. Jung in his Diagnostic Association 
Studies has laid great weight on the lengthened reaction time, and 
also on the inability to correctly reproduce the reaction word, and 
has pointed out that the lengthened reaction time corresponds 
to a complex reaction, and such complex associations show a dis- 
tinct tendency to incorrect reproductions. 

The results of the reproduction experiments show that it is 
chiefly the complex associations which lead to a distortion of the 
reproduction and raises the supposition that in repetition investi- 
gations the complex reactions play a very important role and 
perhaps may be one of the principal causes for the change of re- 
action in repeated experiments. The association experiments 
also point out a means of determining the psychological daily dis- 
position, and the reproduction experiments thus allow a certain 
insight into the constancy and change of the psychological con- 
stellation. 

In his experiments the author used both normal and insane 
subjects, the latter of the dementia praecox type. Each of four 
men and four women, uneducated attendants, were given one 
hundred associations according to Jung's scheme, and the re- 
actions and the time in fifths of seconds of each individual mistake 
was noted. This experiment was repeated with the same words 
eight times, at weekly intervals, with each of the eight subjects. 
At the same time the same experiment was performed with six 
male and five female subjects suffering from pure dementia praecox. 

The work is divided into three parts: the experiments with 
the normal subjects, those with the insane subjects, and thirdly, a 
part devoted to reproduction experiments with six female dementia 

359 



360 The Journal of Abnormal Psychology 

praecox subjects and a female experimenter. Numerous tables 
are given to Illustrate the results which are summarized by the 
author as follows: 



Part I. Normal Subjects 

1. The reaction time. In male subjects the reaction times 
are shorter than in the female. The curve of the average repro- 
duction time decreases slowly and irregularly in the men, in the 
women it decreases rapidly. 

2. Change of constellation. In men the percentage of change 
is less than in women. In men there is first a slow decrease in the 
percentage followed by a rapid decrease; in women a rapid de- 
crease followed at the end of the series by an increase. 

3. The women, on an average, show more than twice the 
number of complex reactions than do men. In the course of the 
investigation the average of complex reactions decreases very 
slightly in the women as compared with the men. Although there 
is a tendency to increase of the complex reactions, the individual 
series show more irregularities than was the case in the series of 
constellation changes or in the reaction times. 

4. If the reactions to the first or second series showed several 
complex reactions, the remainder of the series showed more changes 
than those which were not so marked in the first series. 

5. In the unchanged reactions the average time does not 
reach the general probable mean, but, on the other hand, this is 
markedly overstepped by a changed reaction. 

6. • Frequent changes are to be expected when there is an 
increase in the complex reactions in the first and second series. 
In the second series one may safely say that with an increase in the 
complex reactions one may expect a corresponding greater number 
of changes. 

7. If the reaction time of the first series is increased one may 
expect changes in the next series, and indeed the earlier this occurs 
the more the reaction time increases over the probable mean. 

8. Before a change the reaction time increases over the 
general probable mean, in unchanging reactions it usually remains 
under the mean. 

9. In the repetitions changes especially occur where more 
than the average number of changes follow a stimulus word, 
therefore in complex reactions. 

10. The changes most frequently fall in a row of associations 
which are disturbed by a persevering complex. 



Abstracts 361 

Part II. Insane Subjects 

1. The insane subjects as a rule react three times more slowly 
than do the normal. One notices, however, that in the insane 
there are marked individual differences. The light hebephrenics 
or the paranoid cases do not show any special diflference in the 
reaction time from the normal, in the marked catatonics, however, 
the reaction time is markedly increased. From this one cannot 
say that the individual associations are slowed, but that only the 
expression is retarded. 

The course of the average times is as follows: the men begin 
with a high reaction time which decreases. The women, on the 
other hand, begin with a relatively short time which increases and 
then decreases again. These variations are understood as re- 
sistance phenomena in the psychoanalytic sense. 

2. Reaction changes. There is a greater percentage of 
changes in men than in women. Towards the end of the repeti- 
tions the changes increase. The increase of the changes in demen- 
tia praecox (Schizophrenia) stands in connection with the increase 
of the complexes. 

3 . The number of complex reactions in men rapidly decreases, 
later it does not increase markedly, which is similar to the results 
in normal women. The women show an almost continual decrease 
comparable to that of the normal men. (Reversal of the psycho- 
sexual viewpoint.) 

4. It is also to be noted in the insane subjects that if a re- 
action in the first or second series shows one or more complex 
characteristics there are, as a rule, more changes following than 
if such were not present. 

5. Although the results have no regular value, it is to be noted 
that in the insane subjects, where there are frequent changes in the 
first and second series, there is an inclination to increase of complex 
reactions. 

6. The elementary rules for the change and constancy of the 
constellation found in the normal subjects are also present in the 
insane, the only differences being in the indications of the affective 
focus, for example, the increase in the complex indicators. 

Part HI. Repetition Experiments with Female Experi- 
menter AND Female Subjects 

1. The curve of the average time is nearer the type of the 
corresponding curve of insane men than to that of the women. 

2. The curve of frequency of complex indicators nears the 
corresponding type of insane men as well as that of normal women. 



362 The Journal of Abnormal Psychology 

3. Here also the first and second series is shown to be prognos- 
tically important for later changes. The results again approach 
those of the normal women and insane men. 

Charles Ricksher. 



CONTRIBUTION TO THE PSYCHOLOGY OF THE SO-CALLED DIP- 
SOMANIA. By Dr. Otto Juliusburger. Zentralblatt filr Psycho- 
analyse^ July-August, 1912. 

By dipsomania we understand a recurrent uncontrollable 
craving for alcohol; in the interim the patient is temperate or 
even a total abstainer. There are various theories to explain 
dipsomania. According to Kraepelin and Gaupp dipsomania is 
closely related to epilepsy, inasmuch as the attack develops rather 
suddenly, and it strongly simulates the epileptic mood. Anxiety, 
profound depression, heightened irritability, oppression of the 
head, weariness of life, anorexia, insomnia, and sexual irritation 
stand out prominently in the foreground. Ziehen maintains that 
in fifty per cent of his cases epileptic twilight of consciousness 
(Dammerzustand) was usually present, and only in rare instances 
could an hysterical state be demonstrated. It should be borne 
in mind that in the epileptic cases the amnesia was more strongly 
developed and was restricted to the very early period of the attack. 
One-third of his cases belonged to periodic melancholia, which 
usually ushered in with a marked anxiety afi"ect; the rest of the 
cases were grouped with periodic mania. Ziehen states that he 
had seen cases of dipsomania following pathological intoxication. 
Cramer is of the opinion that dipsomania is not the eff"ect of 
habitual drunkenness, but rather a recurrent pathological state 
determining the dipsomanic attack. Stocker shares Gaupp's 
views, and in his recent book he declares that in his cases, besides 
the dipsomanic attacks, there were other stigmata of epilepsy. 
Wernicke held that the peculiar periodicity of dipsomania could 
only be elicited in a small number of cases, and, therefore, he 
believed that dipsomania could not be grouped with periodic mania. 
According to his conception there is a disturbance in the con- 
tinuity of consciousness; at the break the normal personality 
forms authoctonous ideas, through which alteration and deteriora- 
tion of character results. 

Juliusburger does not agree with Kraepelin, Gaupp, Ziehen, 
and others that dipsomania is a disease process. He holds that 
dipsomania is a peculiar mental state with an underlying psycho- 
sexual mechanism, and in support of his view he describes a case 



Abstracts 363 

in detail and also refers briefly to analyses of other cases. It 
will not be amiss to allude -to the clinical history of the author's 
patient. 

The patient appears to be a young man (the exact age is not 
known), married, and for the past five years has been subject to 
attacks of dipsomania, which recur occasionally, once a month, 
every fortnight, or twice a week, and which last a day and a half; 
in the interim he is said to be temperate. In the attack the 
patient visits the same restaurant; he drinks wine and sack, and 
remains, there till 9 p.m. The restaurant keeper is his relative 
by marriage, and with him the patient calls at another cafe, where 
they continue to drink till he (the patient) again comes to his 
senses. Then he returns home and sleeps for six or seven hours.' 
On the following day the patient does no work, but sleeps most 
of the time. It is interesting to note that in the second restaurant 
the piano is usually playing, and that In neither place are the 
servants female. In the cafe he wishes to sing and express himself 
forcibly; however, he does not utter vulgar or obscene expressions. 
In this state women do not appeal to him, and, as a matter of 
fact, he has no sexual desires. 

In regard to analysis: At the age of seven he drank whiskey 
from a bottle, and following this he had convulsions, but not since 
then. When eleven years old he began to masturbate; the first 
time he had practised this habit with his schoolmates, but they 
did not indulge in mutual onanism. Since the age of nineteen he 
masturbated occasionally, which usually bore a direct relation to 
intoxication. The same was true of married life. At fourteen 
years of age, while doing his lessons In a room where two girls 
were sleeping, one of them seized his hand, with which she fondled 
her genitalia. From the age of seventeen up till the time of his 
marriage he indulged in promiscuous intercourse. 

There are a few facts of his marriage which should be em- 
phasized. The restaurant keeper was his wife's uncle, of whom he 
was very fond. He kept company with the niece, but at one time 
wished to give her up, and for this reason made some effort to 
avoid the restaurant, but was unsuccessful. Finally he married 
her. After marriage he quarreled with her uncle, and at about 
that time his wife left for Vienna. In her absence he did not visit 
the uncle's cafe, and during that period he abstained from liquor. 
Three months later he met the uncle, and was then reconciled to 
him. The uncle Insisted upon his visiting his restaurant, and from 
that time on the patient resumed his habit. 

According to Abraham, craving for alcoholic beverages 
abolishes more or less the sublimation of the homosexual activity, 



364 The Journal of Abnormal Psychology 

and the homosexual component comes to the surface. JuHus- 
burger asks the question whether or -not from the realm of the 
unconscious homosexual activity is capable of stimulating the 
craving for alcohol, sociability, and joyousness, whereby the in- 
verse action of alcohol precipitates the gross outbreaks of homo- 
sexual act. 

In his case the patient was well developed heterosexually, 
and the homosexual component was repressed. The latter sought 
gratification from time to time, and, indeed, by means of alcohol 
he was able to gratify his repressed wish. It must be emphasized 
that after drinking the patient had no desire to consort with women, 
but masturbated freely. Onanism is regarded in his case as a 
homosexual symbol, and Juliusburger maintains that not in all 
cases is the homosexual mechanism the underlying phenomenon 
of dipsomania. In other instances the auto-erotic complex was 
apparently responsible for such a condition. 

The author is of the opinion that there is a striking analogy 
in the mechanism of the alcoholic and that of the masturbator. 
It is well known that there are people who persistently prevaricate 
about masturbation, — even the most trustworthy and honorable 
men are not ashamed to lie upon direct questioning. They deny 
it upon their word of honor; nevertheless they continue to mas- 
turbate. A similar parallel is found in the alcoholics; many people 
cannot resist the temptation of alcohol, although it produces a 
detrimental effect. They promise not to resume this habit, and,, 
moreover, they most solemnly affirm that they have not taken a 
drop of liquor. In spite of that they drink on the quiet. "In 
the ever-recurring wish to enjoy alcohol, preferably by himself 
and in secrecy; in the attempt to deny it to himself; in the inability 
to resist temptation; and in the conflict to lie, and at the same time 
to avow that he leads the life of a total abstainer," — in all this 
there is a strong substitute for the auto-erotic complex. 

Juliusburger offers worthy reflection upon the study of alco- 
holism; indeed it must be remembered that alcoholism and drug 
habit are the most difficult problems in modern psychopathology. 
The mechanism of such habit is not so simple as it appears. It 
would be ultra-scientific to seek explanation in the blind force 
of heredity, in the unfortunate environment, or in the theory of 
auto-intoxication. The persistent, continuous indulgence in 
alcohol and drugs is decidedly psychopathic. In some patients 
we can definitely elicit psychopathic stigmata. Individuals who 
are pr.edisposed to constitutional inferiority of the volitional 
type easily become addicted to alcohol and drugs. If our patients 
would render themselves to more careful scrutiny and study, ab- 



Abstracts 365 

normal personality of a definite type and reaction in the large 
majority of our cases could be possibly demonstrated. 

Mental life is complex, and its complexity bears a direct 
relationship to our longings and cravings, which are determined 
by conscious and unconscious forces. In some other place the 
reviewer has expressed himself in the following manner: 

"Some of our cravings are gratified; others find realization 
In our dreams; still others are repressed and compensated. In fact, 
our mental life is nothing but a readjustment of complex reactions. 
The poet finds recourse to his phantasies; the philosopher gives 
vent to his theoretical speculations; the scientist resorts to his 
inventions and hypothetical theories; the well-balanced normal 
Individual seeks adjustment in healthy activities,— art, literature, 
science, occupations, sport, etc., etc. But the individual with a 
poorly endowed constitution finds refuge in neurosis, psychosis, 
alcoholism, drugs, and other vicious habits. We must recongize 
that the alcoholism Is nothing but a compensation for a complex, 
the fulfillment of which was denied by reality." 

It Is very lamentable that the habitues of drugs and alcohol, 
who come to the physicians for treatment, have already suffered 
considerable Injury from the pernicious influence of those diugs, 
and some are congenitally defective to such an extent as to be 
incapable of subjecting themselves to psychological treatment. 
It Is well known that the continuous us3 of alcohol and drugs 
produces detrimental effects upon ons's mental life; the patients 
lack self-cDntrol; they become emotionally unstable; their judg- 
ment Is faulty and they view serious situations in a superficial man- 
ner; alteration in personality and character results; and they 
gradually show a tendency to lie and deceive. With such patients 
psychotherapy, especially psychoanalysis, is practically of no avail. 
While temporary relief in some instances can be effected, 
permanent cure is hardly conceivable. The psychoanalytic 
method is especially available for such patients only as show no 
evidences of intellectual, emotional, or volitional deterioration. 
At the present time we must be content with the study of the 
personality of the alcoholic and habitue of drugs, and with a 
better knowledge of the psychopathic manifestations In alcoholic 
and drug intoxications we shall be in a position to Institute rational 
prophylactic measures. 

Morris J. Karpas, M.D. 

Psychopathic Pavilion, Bellevue Hospital, New York. 



366 The Journal of Ahnormal Psychology 

LE EMOZIONI E LA VITA DEL SUBCONSCIENTE. {The EmOtioUS 

and the Subconscious Life.) By G. C. Ferrari. Rivista di Psicologia, 
1912, Vol. VIII, No. 2, pp. 93-118. 

Ferrari advances the hypothesis that, just as the cerebro- 
spinal system is the organ of conscious life, so the sympathetic, 
or more broadly, the autonomous nervous system furnishes the 
physiological basis for the emotions and for the whole sphere of 
unconscious life. This hypothesis, which Ferrari refrains from 
calling a theory because of our present imperfect knowledge con- 
cerning the functions and structure of the sympathetic nervous 
system, appears to agree well with the James-Lange theory of 
the emotions. It also accords well with Binet's conception of the 
emotions. According to Binet we must distinguish between an 
emotion and the consciousness of it. The two are not identical 
states. An emotion, for Binet, is a more or less violent mental 
attitude of an indeterminate nature. It differs from an intellectual 
act only in degree. The organic reactions, vascular, glandular, 
muscular, etc., which are the concomitants of any perception sub- 
sume the emotion. The perception of these organic peripheral 
modifications by the brain determines the emotional attitude and 
represents the consciousness of the emotion. But the attitude 
may arise before it is consciously perceived. In other words an 
emotion may exist independent of awareness. This would suggest 
a different organic basis for the two acts, — the emotion and the 
perception of it. 

This functional dualism is a notion apparently supported by 
various clinical and biological data. Consider, for instance, the 
grosser or more primitive emotions, such as fear, anger, etc., 
which are distinguished by James and other psychologists from the 
subtler intellectual and aesthetic emotions. Their manifestation 
is accompanied by very strong peripheral changes, largely motor, 
which we call the expressions of the emotions. In the phyletic 
series these motor responses and other physical reactions on the 
part of the bodily organs and structures had once a protective 
value for the race. Vital functions are governed, in so far as the 
activity of the bodily organs is concerned, by a special nervous 
system. Since this system — the sympathetic — has no other 
function apparently than to control vegetative life and activities, 
it seems but logical to attribute to the sympathetic also those pro- 
tective functions of which the well-known emotional expressions 
and attitudees in man and animals are the external index. Indeed, 
a functional dualism of the nervous system appears to exist even 
as low down in the scale of life as insects. Beetles stung by 



Abstracts 367 

cerces major, a kind of wasp, are paralyzed but do not undergo 
decomposition, under conditions which should favor the putre- 
factive process, so that they are fit food for the larvae of cerces, 
when the latter emerge after the death of their parent. The 
division of the nervous system of beetles into ganglia is not only a 
matter of structural convenience, but apparently implies func- 
tional differentiation as well. The ganglia controlling the vege- 
tative functions of beetles are not affected by the poison of cerces 
as is the remainder of their nervous system. The wasp takes 
advantage of this fact to provide its young with food. 

Clinical proof of the fact that emotions and consciousness 
thereof are two distinct functions or neural acts is found in such 
cases as the one described by D'AUones, in which a melancholiac 
woman (anesthetic over a large portion of her body) showed all 
the external signs of emotion without feeling any. Probably the 
case would not have shown melancholia if there had been com- 
plete anesthesia to emotions, but apathy, as in another case, re- 
ported by Semon; but even in D'AUones' case the contrast between 
the diminished emotional consciousness and the thoroughly con- 
served emotional gestures and attitudes was sufficiently great to 
justify the suspicion of a dualistic function. Some lesions of 
the cerebro-spinal system which were found in this case may have 
impaired the recognition of the subjective emotional state in- 
duced by the functionally normal sympathetic system. Con- 
ditions in other mental diseases suggest a similar hypothesis. 
Progressive paralysis, for instance, is supposed to be induced by a 
degeneration of the cerebral blood vessels and consequently of 
the nervous structure. The patient is euphoric. Rigidity of 
certain peripheral vascular reflexes may account for the blunting 
of the subtler emotions and for the subject's optimism. The 
megalomaniac illusions of the paranoiac are not symptoms of the 
same order: while the progressive paralytic fails to appreciate 
the contrast between his illusions of greatness and his willingness 
to engage in menial work, the paranoiac appreciates the dis- 
crepancy and feels that he must explain his preoccupation with 
tasks below his imaginary station in life. In other words, while 
progressive paralytics (and also melancholiacs) show a distinct 
discordance between the intellectual and emotional spheres, 
suggesting strongly a functional dualism of the central and sym- 
pathetic nervous systems, the dissociations peculiar to paranoiacs 
point to a splitting up of functions or a dualism taking place 
wholly within the sphere of cerebral activity. Such widely 
different traits as gregariousness in the sphere of social psychology, 
and, in that of individual psychology, interest, which is the main- 



368 The Journal of Abnormal Psychology 

spring of attention, as well as of the whole mechanism of memory, 
and which controls largely our associations, may be looked upon as 
functions of the sympathetic, — tendencies insufficiently individ- 
ualized to become conscious but powerful enough to determine 
our emotional disposition, to modify and regulate our conduct, 
leaving to consciousness the justification of their operations and 
end results. Incidentally this suggests a theory of habit superior 
to what has been propounded heretofore. 

It seems that certain stimuli may affect the sympathetic 
nervous system directly. This may be the case particularly with 
the instinctive and apparently unreasonable attractions and 
repulsions in animals. The sensitiveness of some persons to a 
cat, of whose presence they are not otherwise aware, the tremor 
of limbs, perspiration, and other signs of fear in horses that have 
to travel a path crossed by some wild animals, and other such 
familiar facts indicate a deep-seated defensive reaction probably 
under the control of the sympathetic. Indeed it is hardly likely 
that such protective reactions were relegated to the brain centers 
at some period in the phyletic history of the race, only to be trans- 
ferred back to the sympathetic. The external manifestations of 
emotional life, it will be recalled, are vaso-motor, glandular, etc., 
that is, they are based upon contractions ofunstriated muscular 
fibers which are under the control of the sympathetic. The 
traces of muscular contractions which German psychologists call 
Bezvusstseinslage, and which play an important role in experimental 
work, may also owe their mechanism to the control of the sym- 
pathetic, and may be a reflex of the same order as the ciliary or 
ocular recti muscle response. 

J. S. Van Teslaar. 



UEBER GEGENSEITIGE ANZIEHUNG UND BEEINFLUSSUNG PSY- 

CHOPATHiscHER PERSONLicHKEiTEN. By E. Meyer and G. Puppe. 
Fierteljahrschrift /. gerichtliche Medizin und Oefentl. Sanitdtszve- 
sen, III Sen, 1912, p. 33. 

The authors have had opportunity to study in some detail the 
mutual influence of two psychopathic characters who jointly com- 
mitted a crime the details of which had been exploited widely by 
the German press and herein present their findings and conclu- 
sions. 

The woman in question, Madame V. S., showed distinct psy- 
chopathic traits, including some hysterical stigmata; she was ner- 
vous, high strung, complained of headaches, vertigo, faintings, and 



Abstracts 369 

suffered of cramps as well as of repeated attacks of paralysis of 
her limbs; her bodily activities were at low ebb so that she com- 
plained of a disagreeable feeling of weakness, of inability to meet 
the issues of life. On the mental side she showed, besides, great 
irritability, very unstable temper, weakened will power and cor- 
responding heightened suggestibility. Her moods changed fre- 
quently, she flew easily into rage if she could not have her way; a 
number of times she attempted suicide, though perhaps not very 
seriously. She had also passed through periods of confusion with 
partial or total amnesia. Higher ethical concepts were wanting 
in her, though she covered her shortcomings in this respect rather 
cleverly. Upon those close to her she made the impression of 
being an overgrown child, pampered and spoiled as are many of 
the women belonging to her social set who lack any serious aim in 
life. Those who knew her less intimately failed to notice anything 
out of the ordinary in her, so that she passed for a normal person. 
As is almost universally the case with such persons her sexual life 
was far from normal. She possessed a distinctly perverted sexual 
trait. The infantile character of her sexual longings and fancies, 
though perfectly clear, remained apparently unrecognized by the 
authors of the present study. Thus, for instance, they speak of 
her wailings over the death of her husband and parents as wilful ex- 
aggerations. It seems strange that the authors should have no ex- 
planation to offer for the woman's tenderness towards the dead be- 
yond the flimsy and superficial remark that it is the product of her 
morbid phantasy and in keeping with her tendency to exaggerate. 

The data concerning the man in the case are less thorough, 
but the authors have learned sufficiently about him to enable them 
to give a fairly comprehensive outline of his mental make-up. He 
was an army officer, well educated, a very efficient and energetic 
man and of high social standing. He, too, possessed certain psy- 
chopathic traits. The important point about the man, according 
to the authors, is that these traits burst forth with full force only 
upon his unhappy association with the woman. It required the 
psychopathic character of a woman like V. S. and intimate asso- 
ciation with her to bring about V. G.'s downfall. 

The trait in his character which furnished perhaps the 
strongest bond of union between the two was his passion for heroic 
display. He was vainglorious to a morbid degree, ready to rush, 
Don Quixote like, to the assistance of one in apparent or real dis- 
tress, if by doing so he could figure as a daredevil. His military 
career, undoubtedly, and the traditions of military life have had 
something to do with the sharpening of his character just as the 
particular trait in question may have been what turned him, in 



370 The Journal of Abnormal Psychology 

the first place, upon a military career. His sexual life was also 
steeped in the subnormal. He possesseed homosexual traits and 
was addicted to various perverse habits with the result that he 
brought himself Into a state of psychic Impotence. His tendency 
to exaggerations and particularly his marked cynicism were no 
doubt intimately related to his sexual abnormalities. 

It was but logical that a man of daring type should appeal to 
the weak-willed character of Mme. V. S. The weak always ad- 
mire the strong just as the hungry envy the well fed and small- 
souled moral weaklings are loudest In the praises of virtue and 
honor. Moved at first by compassion for the woman's unfortu- 
nate situation within her family circle and later by jealousy, V. G. 
plots to obtain her freedom. In keeping with his erratic spirit and 
joy of adventure his plans, instead of revolving within the bounds 
of socially countenanced action, assume the wildest and most ex- 
treme forms. Robbers' masks, poisoning, shooting, all the deeds 
of romantic fancy figure in his plans. The woman nags him on 
with stories of sufi'ering and distress until the desire to help her out 
of the situation becomes an obsession with him. 

In contrast with his attitude the woman, weak of will, though 
nagging him on, is at the same time secretly taking measures to 
avoid serious conflict. Not only does she lack the will but at 
bottom she lacks even the wish to become free. The situation in 
its tense and strained form aff^ords her immense gratification. She 
adds to her secret delight by Intensifying the situation with new 
stories of maltreatment. 

The particular point which the authors emphasize in this study 
is the fact that, in a certain sense, the two psychopathic characters 
figuring In this drama completed each other. Through the Inter- 
action of their traits they rounded out a type capableof committing 
a crime of which neither person alone would have been guilty, so 
that the crime may be said to have been committed by a sort of 
composite personality. But the Interdependence of character and 
traits not only among psychopaths but throughout social life is 
universally recognized; the fact itself is too common to require 
additional documentation, so that this feature is not the most im- 
portant, and certainly not the only one that should have been 
sought out in connection with such interesting data. Whenever 
two persons are thrown together it is fatal that they should react 
upon and influence each other. So thoroughly is this fact acknowl- 
edged that the mutual influence of psychopathic and other types, 
for good or bad, forms the perennial theme exploited in every form 



Abstracts 371 

of literature and figures In every dramatic plot from the serious 
'* problem" play to the one act melodrama. With the data that the 
authors have had the opportunity to obtain from their subjects 
who were Intelligent enough and also willing to give a complete ac- 
count of their inner experiences, a psychogenetic analysis of the 
earliest character-forming experiences of childhood would have 
been possible. Not only would have such a study proven 
well worth while, but incidentally it would have furnished definite 
mean^ of ascertaining just what importance may be justly as- 
cribed to the mutual influence of the psychopathic characters under 
consideration. One of the most important contributions of psy- 
choanalytical research is the evidence It brings forward showing 
that the fundamental traits of our character are formed In Infancy 
and early childhood; these traits may be brought into bold relief 
in their blunt form or may be sublimated Into ethically higher 
forms, but they are not moulded anew by the accidental meeting of 
some person or other in adult life. 

J. S. Van Teslaar. 



APROPOS OF THE DOCTRINE OF RESERVE ENERGY. By 

Tom A. Williams, M.B., C. M., Edin. Presented to the Southern 
Society of Psychology and American Association for Advance of 
Science at Washington, December, igii. 

Using the conception of the subconscious as applying to a 
special series of nerve processes, energizing independently of those 
which are the bases of the thoughts of everyday life, a psycholog- 
ical theory has arisen that these subconscious processes constitute 
energies which may be regarded as a reserve (James) susceptible 
of being utilized by means of special assoclationizing processes. 
On this basis a therapeutic method is employed. (Sidis.) 

This theory depends upon the postulate that the threshold of 
excitation Is somewhat inversely proportionate to the richness in 
associations of the constellation to be excited. This postulate re- 
gards the inhibition of energy as synonymous with its storage, 
forgetting that inhibition itself Is a greedy consumer of energy. 
So that the absence of manifestation of energy, to a superficial ex- 
amination at least, does not connote its storage or reserve on these 
giounds at least. 

Nor is the fact that useful work Is not done by any means an 
Index that energy is not expended; for a very little observation 



372 The Journal of Ahvormal Psychology 

shows that it is extended in fatuities and sterile activities. 
(Author's Precocity, Ped. Sem. 1911.) 

So that the principle of channeling energy would be more 
correctly substituted for the principle of reserve energy. The re- 
sult of what is called training, that is, technical methods clearly 
show this difference. (Human Engineering.) The trained man 
may spend less energy than the untrained man, but his work is more 
effective in result because more wisely expended. 

Author's Abstract. 



REVIEWS 

laughter: an essay on the meaning of the comic. H. 
Bergson. Translated by V. Brereton and F. RothwelL The Mac- 
millan Company, New York, 1911, pp. vi, 200. 

Those familiar with Bergson's philosophy know what em- 
phasis this thinker lays upon the elasticity, the uniqueness, and 
irreversibility of all modes of human life. Any action that tends 
away from the wonted elasticity towards the reversible, the 
stereotyped, or mechanical is recognized instinctively as untrue 
to life and provokes laughter. The comical, then, consists of the 
splitting into parts, its fundamental theme is the tendency to a 
mechanization of what should appear only as an evolving con- 
tinuum. 

Laughter is a social instrument for the correction of all tend- 
encies towards the inelastic, the stereotyped, or the mechanical 
in human life. As such laughter implies a certain amount of 
indifference. At any rate the comical, the object of laughter, lies 
outside the sphere of one's direct interest or concern. Anything 
that relates directly to our struggle for existence cannot very well 
serve us at the same time as the object of derisive correction. We 
can ill afford to laugh at a joke at our expense. If our emotions 
participate strongly in a certain act, if we are particularly inter- 
ested in our neighbors, we are rendered thereby unable to appre- 
ciate the comical in them. The ideal condition of the comical 
is one of aloofness: the attitude that favors it best is that of 
simple curiosity not weighted down by any self-interest. It is 
only in such an attitude that laughter exercises fully its corrective 
influence. 

Comedy revolves around the similar and the typical. It is 
therefore unlike art, which aims to " bring us face to face with 
reality itself," and also unlike reality or life, which is a struggle 
away from the mechanical; it occupies a sphere of its own between 
true life and the artistic representation thereof. 

These are, iji brief, the principles on which Bergson explains 
the meaning of laughter and of the comic. Conceived as they 
are in charming language of unsurpassed poetic beauty, it is little 
wonder that within the dozen years or so that the work has been 
before the public it has reached numerous editions in France and 
other countries. The author's analysis of art, contained in this 
work, though incidental to its main theme, has become justly 
celebrated and is looked upon by some as containing some of the 
happiest thoughts which have been penned on this subject. 

373 



374 The Journal of Abnormal Psychology 

The English translation is fairly satisfactory. Bearing in 
mind that Bergson's peculiar style renders the task of translating 
his thoughts into foreign dress full of difficulties, one may pass over 
lightly some slight inaccuracies and a few inelegant expressions 
occurring particularly in the first part of this English rendition. 

J. S. Van Teslaar. 



UBER DEN TRAUM. EXPERIMENTELL-PSYCHOLOGISCHE UNTER- 

sucHUNGEN. /. Mourly Void. Herausgegeben von O. Klemm. 
Leipzig. 2 vols. 1910-12. 

These two volumes contain a complete record of certain 
experimental researches on sleep extending over a period of years. 
The author's object was to study the influence of somatic stimuli 
upon the production of dreams. The experiments are given in 
full. They consisted mostly of the application of stimuli to the 
foot, ankle, arms, or back. The records of dreams obtained during 
the experimental sleep were compared with the subject's dreams 
under ordinary conditions. The observations abound in details 
which are interesting in themselves, but the practical bearings of 
which are difficult to estimate. It seems that the author has gone 
to considerable trouble to record deductions in the main well 
known. The work has the merit of embodying the largest amount 
•of experimental data on the subject with which it deals, but new 
results are even more scant than those which Maury obtained 
over a quarter of a century ago. 

Various Freudian notions are corroborated in this work. 
Flying, for instance, also the mounting steps, have been found to 
be related to sexual fancies. It is particularly interesting to note 
that the Freudian contention that many dreams represent 
memories of one's own birth experience is also corroborated. 

J. S. Van Teslaar. 



DEMENTIA PRECOX ODER GRUPPE DER SCHIZOPHRENIE. A. 

Bleuler. F. Deuticke, Leipzig und Wien. 1911. 

Bleuler's conception of dementia praecox is very broad. It 
includes a great number of the disturbances hitherto classified 
loosely among the psychoses. The condition is not a species of 
•disease, but partakes of the nature of a genus having varied clinical 
manifestations which frequently masquerade as diff"erent noso- 
logical entities. In fact, Bleuler recognizes no distinct line of 
•cleavage between dementia praecox and the normal state. On the 
'Contrary, In keeping with the modern dynamic conception of our 



Reviews 375 

mental activities, he maintains that all degrees of transition from 
one state to the other may be met. The schizophrenic state may 
be latent, and an acute outbreak may be due to various inciting 
factors, but these should not be looked upon as the real cause of 
the condition. 

The term dementia prsecox is considered misleading. Bleuler 
prefers the designation schizophrenia because it recalls to mind 
the most characteristic feature of this large group of cases, namely, 
the splitting of the psychic functions. Throughout the work, 
although emphasis is laid upon the psychological aspects, no other 
important feature of the subject is neglected. It is evident that 
all the sources of information available on this subject, from the 
classical work of Kraeplin, whose services are fully recognized by 
Bleuler, to the latest psychoanalytical researches have been 
drawn upon to supplement the author's own painstaking clinical 
studies. This work will rank as an excellent specimen of German 
scholarship and learning. 

The author's division of clinical manifestations into primary 
and secondary is already known. The symptomatology of 
dementia praecox considered thus far was largely secondary and, 
in a sense, superficial. It is only within recent years that the pri- 
mary and really pathognomic features of this group of disorders 
have been recognized. In the first part are discussed the funda- 
mental symptoms, — the loss of proper power of synthetization as 
shown mostly in stereotypies, and the insulation of affectivlty, — 
the change in the emotional attitude progressing to complete 
apathy. The subject's grasp of reality becomes markedly im- 
paired on account of his loss of the faculty of synthetization; 
dreamy states become predominant, leading to so-called dementia. 
The subject's intellectual condition depends upon the nature of 
the complexes; he is insane only with reference to certain con- 
stellations or complexes. The primary modifications in the sub- 
ject's aifectivity and ideational processes form the background for 
and determine the course of the well-known secondary symptoms. 
Certain somatic disturbances are included by Bleuler in the 
category of primary symptoms; among these are some forms of 
metabolic disorder and of central paralysis with which it may be 
associated, inequality of pupils, vaso-motor troubles, the tremor 
of acute states, the edema, certain catatonic attacks. There are 
also present, in the psychical sphere, as part of the primary syn- 
drome, certain disturbances in the associative processes, particu- 
larly a flattening of the association types. A peculiar disposition 
to hallucinations and to stereotypy are probably also among the 
primary symptoms. 



376 The Journal of Abnormal Psychology 

Bleuler's well-known classification of the condition into four 
distinct groups — the paranoid, catatonic, hebephrenic, and 
simple schizophrenic — is explained fully in the second chapter, 
devoted to a discussion of the secondary symptoms. Here the 
sensory illusions, memory disturbances, and alterations of per- 
sonality, as well as the usual somatic disorders and acute syn- 
dromata, including the catatonic symptoms, are considered very 
carefully. 

The tenth chapter, devoted to the psychopathic theory of 
dementia praecox, is undoubtedly one of the most important, and 
may rank as a classic in psychiatric literature. The author's 
extreme caution is noticeable throughout. He does not appear 
anxious to assume an air of finality even about conclusions but 
little susceptible of doubt. Briefly stated the etiology of schizo- 
phrenia is formulated by Bleuler somewhat as follows: The symp- 
toms of this condition represent positively, in part, and possibly, 
as a whole, nothing more than a more or less unsuccessful attempt 
to escape from an unbearable situation. The primary symptoms 
alone represent, properly speaking, or stand for the schizophrenic 
condition. The secondary symptoms are psychic functions under 
altered conditions, and represent an attempt at readjustment 
with the conditions created by the primary disturbances. The 
attempt may be more or less successful in a certain sense, at times 
it is wholly so. 

A thorough understanding of the psychogenetic foundations 
of this disorder can be gained only through the application of the 
psychoanalitical method of research. In spite of all care taken to 
avoid leading questions it was found that in most patients all 
pathogenic complexes were sexual. In certain few cases other 
complexes were found responsible for the condition, and sexual 
complexes apparently stood in no closer relationship to these 
pathogenic factors than they may bear associatively to almost 
any complex within the mental sphere. This was the case more 
often among men than among women. In a few instances, also 
among male patients, it seemed that the sexual complex was 
actually overshadowed by other pathogenically more active com- 
plexes. On the whole, however, sexuality furnished by far the 
greatest number of complexes in nearly every instance. One 
consulting this work should not fail to appreciate that psycho- 
analysts are by no means inclined to ascribe to the sexual com- 
plex a greater role than Its importance warrants; nor do they 
arbitrarily reduce everything to terms of sexual symbolism, as 
some suspicious critics would like to think. Bleuler has been as 
careful and guarded in his conclusions as a true man of science 



Reviews 377 

should be. If psychoanallsts seem to over-accentuate the role 
of sexuality it is because this factor has been so misunderstood and 
neglected, even avoided, thus far, that to uncover its true import 
alone is sufficient to create the illusion of undue stress in the minds 
of those who, for one reason or another, would rather avoid the 
subject. 

J. S. Van Teslaar. 



l'aNALYSE PHYSiaLOGIQUE DE LA PERCEPTION. E. AhrU- 

mozvski. Collection de psychologie experimentale et de metapsy- 
chie, Vol. XX. Paris, Bloud et Cie. 1911. Pp. 120. 

This monograph is devoted, as is indicated by its title, to a 
discussion of the neural foundations of perception. The doctrines 
presented in the first part of the work will find ready acceptance, 
as they are, on the whole, in agreement with current psychological 
teachings. Thus, for instance, the theory, serving as a founda- 
tion for this analysis of perception, that every state of conscious- 
ness is traceable to a group of active physiological elements, 
chiefly nervous, is one commonly accepted and no valid argument 
can be raised against it, except where it is implied that these active 
physiological elements exhaust the whole content of the con- 
scious state, as this author seems to maintain. 

Numerous factors enter into every act of perception. A 
visual perception, for instance, implies the stimulation of certain 
sensory areas, peripheral, subcortical and cortical, and of a group 
of mnesic foci located in the frontal lobes, the stimulation of 
which serves us the purpose of particularizing the object respon- 
sible for the optical stimulus by giving it the character of "some- 
thing known"; certain simultaneously aroused coenesthetic re- 
actions invest the whole experience with a more or less definite 
affective tone; finally the simultaneous activity of other sense 
organs, though for the time submerged below the threshold of 
awareness, contributes something to our manner of perceiving the 
visual stimulus in question. 

The author's classification of mental processes is interesting. 
Starting with their physiological correlates as a basis, all mental 
processes are grouped into four categories. This division depends 
on the relations between the various neural foci which are aroused 
more or less simultaneously, the order of their succession and their 
mutual influence. Presumably every aroused neural group has a 
stimulating effect upon the neighboring ones. Then, too, every 
new activity must exercise some inhibitory influence upon the ones 
immediately preceding. We may have therefore (1) the case of a 



378 The Journal of Abnormal Psychology 

new neural group aroused associatively and joined to a previously 
active group or chain of groups, giving rise, on the psychical side, 
to subjective variations in perception and consequently to changes 
in judgment. (2) Or the dissolution of part of the chain; some 
foci simultaneously aroused in an act of perception may become 
released so that the perceptive function is carried on only by the 
remainder; psychologically this gives rise to dimness of perception, 
ordysgnosia, and is recognized as fatigue as indicated by the down- 
ward slope of the attention curve. (3) Furthermore the active 
neural foci, after a portion of the chain originally aroused by some 
stimulus has lapsed into disuse, may attach themselves to a new 
group; this may be assumed to be the neural counterpart of as- 
sociation of ideas. (4) Finally, the sudden arousal into activity 
of a dormant chain may cause an equally sudden arrest of some 
functionally active group or chain of neural foci and may thus bring 
about, on the subjective side, violent emotions and possibly also 
the various states and degrees of suggestibility. 

Equally interesting are the author's observations on the in- 
fluence of different moods upon the character and quality of our 
perceptions. The state of joyful expectancy, for instance, lends a 
brighter coloring and a greater luminosity, a more cheerful air 
about the objects of our perception. In the "depressed" mood 
the colors are correspondingly subdued and * 'toned down." This 
is a subject of particular interest to psychopathology. 

The author defends the popular notion that, in their last anal- 
ysis, nervous processes are but a counterpart of metabolic changes. 
Psychism is mainly, if not wholly, a matter of neuronal nutrition. 
Not only that part of the nervous system which is the seat of meta- 
bolic activity at a given moment enters into the formulation of 
consciousness at that moment, but as all bodily tissues undergo 
metabolic changes, the whole body may be said to be divisible 
into a part that is living because active and a part that is dormant; 
and in a certain sense it may be said that consciousness inheres in 
the whole " living " part. Recourse must be had to the method of 
concomitant variations in order to determine exactly what this 
living part may be at any particular moment. 

These are, in outline, the author's contentions. A glance at 
the philosophical problems involved reveals many vulnerable sides 
to such hypothetical speculations, but a review is not the proper 
place in which to refute them. It may be pointed out only, in pass- 
ing, that by carrying his materialistic conception of psychic func- 
tions halfway across the length to which it leads logically, the author 
finds himself in the very midst of a vicious circle out of which his 
materialistic doctrines could not help him emerge. The admission 



Reviews 3 79 

•of a role to non-nervous structures in the synthetization of con- 
sciousness is the last thing one would expect from a writer who 
would revamp for us Moleschott's phosphorus theory of brain 
activity. There is but a slippery step from the notion that non- 
neural structures, by reason of their metabolic processes alone, 
are capable of taking part in the highest form of psychic activity, 
•consciousness, to the doctrine of panpsychism, the very extreme 
which such writers as the one under discussion strive to avoid and 
against which all materialistic hypotheses are directed. 

J. S. Van Teslaar. 



STUTTERING AND LISPING. E. W. Scfipture, M.D., Ph.D. 
New York, MacMillan Co.,. 1912. Pp. viii, 247. 

All the forms of stuttering and lisping are treated under three 
general heads in this new book on speech defects. First, each 
form is discussed from an etiological standpoint; for example, from 
that of an anxiety neurosis as a cause for stuttering; or of the spas- 
ticity in speech as a neuropathic disposition in the background; 
or of the stutter that comes from seeing ghosts, fire scenes and sur- 
gical operations. 

Secondly, the mechanism — the physical functioning speech 
mechanism — that expresses the stutter or lisp in speech is analyzed 
and illustrated in prints of numerous kymograph records, faces 
in contortion and other externalizations. 

And thirdly, the treatment is followed in great detail, based 
of course on the well-investigated etiology and executed with re- 
gard to the proper vocal mechanism and psycho-physiological re- 
lations. For example, the treatment of lisping after its classifi- 
cation into organic, neglect and neurotic lisping with explanation 
of the mechanism is described. Exercises for breathing, inculca- 
tion of slowness and enforced proper thinking are outlined and 
presented. 

In the course of the investigation of etiological factors the 
book takes up in a brief but clear way psychoanalysis, showing 
how (1) the material of dreams comes from the preceding day; 

(2) how every dream is a wish fulfillment still unfulfilled; and how 

(3) the language of dreams is not direct except with children, but 
isymbolic. 

In another place an outline for voice examination is given 
with lists of surds, consonants, acclusives and fricatives, with their 
numerous ways for defective expression and the treatment therefor. 



380 The Journal of Abnormal Psychology 

Thus almost one hundred pages of clear, concise presentation 
of voice defects, their diagnosis and treatment, makes the best 
treatise on the subject In English yet published. 

Walter B. Swift. 



TRAUM UND TRAUMDEUTUNG ALS MEDIZINISCH-WISSENSCHAFT- 

LiCHEs PROBLEM IM MiTTELALTER. Puul Diepgeu. Berlin, 
J. Springer, 1912, pp. 43. 

The recent revival of scientific interest in dreams extends to 
the historical and cultural aspects of the subject. Diepgen's 
monograph is devoted to the medieval theories concerning the 
origin and meaning of dreams. It is based on carefully selected 
sources and reviews with considerable accuracy the misty, specu- 
lative atmosphere of medieval thought as portrayed In the specu- 
lations concerning dreams and their meaning. 

Needless to add, there Is little In these speculations that appeals 
to the scientific spirit of to-day. To the modern, practical mind, 
the naive ebullitions of a dogmatic age unacquainted with the 
modern methods of scientific analysis appeal only as curiosities 
of thought. The dream theories which were prevalent during the 
Middle Ages are thoroughly characteristic of the ecclesiastic atmos- 
phere which pervaded every form of speculation at the time; they 
show the usual servility towards the great arbiter of medieval 
thought, Arlstoteles, and but little more. 

Occasionally a bright thought or some happy induction 
strikes a note of discord in the midst of the senseless mire of eccle- 
siastic mysticism so characteristic of the medieval spirit, and re- 
minds one that even the heavy dogmatlcism of the medieval period 
was unable to stifle altogether the common sense of men who would 
dare think for themselves. The writings of Albertus Magnus are 
particularly surprising In this respect. His Summa Theologica 
and Summa de Creaturls contain some observations which, taken 
by themselves, sound like the common-sense observations of a 
modern type of thinker. Thus, for instance, the fulfillment of 
certain dreams portending disease is explained without appeal to 
the supernatural (something many a "modern" mind has not yet 
learned to do). The explanation which Albertus Magnus offers 
is so simple and logical that it can hardly be improved upon to-day; 
and Bergson, for instance, in a lecture on dreams, a few years ago, 
explained the occurrence of dreams foretelling disease on the same 
basis. 

Such dreams, Albertus Magnus explains, are actually caused 



Reviews 381 

by the earliest beginnings of the disease. The symptoms, weak at 
first, are registered by the mind earlier during sleep when the mind 
is not distracted and wholly absorbed by the stronger stimuli 
from the surrounding world. Many slight irritations from the 
body or stimuli from the outside remain unobserved during the 
waking state because they are overshadowed by the stronger 
excitations and stimuli incident to active daily life. With the on- 
set of sleep, the mind, relieved of attention to the stronger stimuli, 
turns to the weaker impressions demanding recognition. 

This medieval writer is bold enough to suggest the possibility 
of mere coincidence to explain why some dreams come true, but 
too much stress need not be laid on this point, as his "incursus 
accidentalis" is a medieval concept which has lost standing in 
the field of science. 

On the whole it must be said that medieval theories of dreams 
have little to commend them to the attention of practical people. 
Attempts at dream interpretation were common, but the work 
depended entirely on the physician's or interpreter's ingenuity; 
phantasy and speculation of the wildest character had free play. 

The role of symbolism in dreams was well recognized, but no 
working principle had been discovered. It is characteristic of the 
people's attitude towards the subject of sex that, of all things, 
reference to sex matters was rigorously avoided in dream interpre- 
tation. In view of the fact that sexual incidents intrude boldly 
upon the latent content and frequently also upon the manifest 
content of dreams in such a way that their sexualcharacter is un- 
mistakable, it is certainly reasonable to surmise that the medieval 
mind required a considerable amount of repression in order to avoid 
seeing anything relating to sex in the interpretation of dreams. 

Dreams had no particular diagnostic significance in the Middle 
Ages. A dream could mean anything because everything de- 
pended upon happy analogies, and these were limited only by the 
interpreter's ingenuity. The dream had to do with the state of 
admixture of the bodily fluids or of the brain fluids, the tempera- 
ment and the humoral diseases of the subject. The Influences 
which made themselves felt In the Interpretation of dreams during 
the Middle Ages, aside from the Aristotelian doctrines, emanated 
from the Orient and were chiefly Arabic. 

The interpretation of some dream symbols is very significant 
and would repay careful analysis In the light of medieval habits of 
thought and culture. Thus, for Instance, a snake in dream is 
looked upon by Arnold von Villanova as symbolizing an enemy, 
or at any rate evil. The occurrence of narrow passages forebodes, 
according to Rhazes, some ailment of the respiratory passages or 



382 The Journal of Abvormal Psychology 

difficulties of breathing. Such interpretations are, in their turn,, 
worthy of psychoanalysis. 

J. S. Van Teslaar. 



BIOLOGICAL ASPECTS OF HUMAN PROBLEMS. Christian A, 
Herter. The Macmillan Company, New York. 1911. Pp. xvi,.. 
344. 

This posthumous essay of Professor Herter, late of Columbia 
University, reminds the reviewer somewhat of Huxley. Taken as 
a whole, with the accent on biologic psychology and again on the 
social sex-relation, it constitutes an important contribution to the 
essay literature of recent years. The book lacks an index, and so 
greatly exaggerates the mechanistic view of life as to deny the free- 
dom of the human will — these are its two glaring defects; neither 
of these, however, lessens its interest as a discussion of biologic 
socio-psychology. 

The essay is divided into four "books": I, The Animal Body as- 
a Mechanism; II, The Self-Preservative Instinct; III, The Sex 
Instinct; and IV, The Fundamental Instincts in their Relation to 
Human Development. The first of these deals with the notion of 
mechanism, heredity, and "Consciousness and the Will." Scien- 
tific fatalism and a somewhat veiled but out-and-out materialism 
are the heavy burden of this first part. "If we admit that the 
physical processes in the brain precede and cause thevarious phases- 
of psychical life, we are forced to the assumption that the human 
animal is a conscious automaton. The consequences of this hypoth-^ 
esis are' far-reaching and incisive." Every man certainly would 
admit these statements, and many, especially the multitude who- 
feel more deeply than the microscope penetrates into human nature^ 
will deplore a philosophy that goes no further. (The most curious 
thing about all these assertions that a thinking personality, even 
while constructing a meaningful contribution to the wisdom of the 
world, is a "conscious automatism" is that not a mother's son of 
them actually or literally believes it, protest he how he may!) "Ac- 
cording to this [deterministic] view," says the author, "the sensa- 
tion of willing is never primary or spontaneous, but always marks a 
reaction of the nervous system to some impulse or group of im- 
pulses originating ultimately outside the body." Here Professor 
Herter, and others who argue thus, like all disciples of Hobbes and 
of a narrowly false conception of Spinoza, are the veritable victims 
of a prejudice as dogmatic at least as ever animist expressed; for 
cold scientific analysis of the determinants of voluntary move- 



Reviews 383 

ment will show any man (or else nearly all humanity is perpetually 
beguiled) that experiences, immediate experiences described in no 
text-book of physics, precede and determine every deliberate bod- 
ily movement. The ethics suggested in " nil nisi bonum, etc., " must 
not be extended to include a thesis even in a posthumous book so 
ultra "mechanistic" as this. Yet the higher wisdom, if it be not 
found in Wm. McDougall's "Mind and Body," is at least beyond 
cavil in a pragmatic and immortal word of the discursive but clear- 
seeing Cicero on truth: "Hi sumus, qui omnibus veris falsa quae- 
dam esse dicamus, tanta similitudine, ut in iis nulla insit certe 
judicandi et assentiendi nota." We owe Professor Herter much for 
clear argument even on a trite theme and even to a conclusion 
which the present reviewer deems wholly unjustified by facts and 
principles far outside the range of biology. This is the sanction 
for including in a magazine devoted to abnormal psychology a 
review of this interesting essay. 

Book II has a wealth of important biological and medical 
facts bearing on the instinct of self-preservation broadly considered, 
while Book III is a brief but thoughtful and frank discussion of 
the sex problems of society from the important biologic viewpoint. 
Book IV, on human development, contains valuable new com- 
parison of dancing, music, and painting in some of their more 
patent biological relations, and the bodily basis of religion is 
briefly suggested. One chapter of this part deals with education, 
especially on the latter's need of sexual instruction and on the im- 
portance of observation and of the development of a primary power 
of judgment and of reason. "The problem of education is hu- 
manity's greatest problem, as it always has been and always will 
be." The last of the thirteen chapters of this volume deals with 
"the fruits of education," and among these "are an improvement 
in the position of women, changes in the distribution of the profits 
of business, changes in the methods and ideals of government, a 
great extension of the activities of science and of art, and some 
radical changes in the attitude of religious teachers," — these by 
the opening up of physiological paths. 

Altogether this volume from the now silent pen of Professor 
Herter is an important contribution to many current problems 
from a standpoint strictly biological and mechanistic. In the 
former trend it certainly is in the most productive line of educa- 
tional thought, and always it is interesting. 

G. V. N. Dearborn. 
Tufts Medical and Dental Schools. 



384 The Journal of Abnormal Psychology 



BOOKS RECEIVED 

A METHOD OF MEASURING THE DEVELOPMENT OF YOUNG CHIL- 
DREN. By Binet and Simon. Translated by Clara Harrison Towne. 
The Courier Co., Lincoln, 111. 1912. ^1.00. Pp.83. 

THE KiLLiLAK FAMILY. By H. H. Goddurd. The Macmillan 
Company, New York. ^1.50. Pp. xl, 117. 

INSTINCT AND EXPERIENCE. By G. Lloyd Morgan. The 
Macmillan Company, New York ^1.50. Pp. xvii, 299. 

AN INTRODUCTION TO PSYCHOLOGY. By WUhelm Wuudt. 
Translated by Rudolf Pintner. The Macmillan Company, New 
York. 90 cents. Pp. xi, 198. 

THE MEASUREMENTS OF INDUCTION SHOCKS. By Emest G. 

Martin. John Wiley & Sons. 1912. ^1.25 net. Pp. vii, 117. 

OUTLINES OF THE HISTORY OF PSYCHOLOGY. By Max Dessoir. 

{Univ. of Berlin.) The Macmillan Company, New York. 1912. 
^1.60 net. Pp. xxix, 278. 



^^ 



{ 



THE JOURNAL OF 
ABNORMAL PSYCHOLOGY 



FEBRUARY-MARCH, 1913 



A PSYCHOANALYTIC STUDY OF A SEVERE CASE 
OF HYSTERIA 

BY L. E. EMERSON, PH.D 

Psychologist, Neurological Service, Massachusetts General 

Hospital; Examiner in Psychotherapy at the 

Psychopathic Hospital, Boston 

THE followingpsychoanalysis lays claim to no subtlety 
of technic. Credit for concreteness is the only 
credit it can claim. It is deemed worthy of publi- 
cation because the psychopathological processes, 
together with their causes, or to be strictly logical, their in- 
dispensable conditions, are so gross as to be easily discernable. 
The last of January, 1912, there was referred to me, for 
psychoanalysis, a girl of about twenty-two years of age. She 
was unable to keep anything on her stomach. Neither food 
nor water would stay down. This commenced, she said, 
about six months ago. Recently, however, she had had 
also several serious convulsions. She had had convulsions 
before, off and on for about a year, sometimes having as 
many as five in one day, but had seemingly recovered from 
them, some two or three years, previously, at a sanitarium, 
where she had been sent for rest and treatment. The re- 
covery then had seemed to be associated in some way with 
the death of her mother, which had occurred suddenly, quite 
unexpectedly. She said, "It came over me that I had to get 
better and I started gaining right off." From that time till 
last summer she had remained free from both convulsions 
and vomiting. 

The girl lived at home with her father and an only 

385 



386 A Psychoanalytic Study of a Severe Case of Hysteria 

brother, a boy several years younger, for whom she felt a 
mother's responsibility, and to take care of whom, she said, 
she had really recovered before. But now he seemed no 
longer to need her care and the convulsions returning as 
well as the vomiting, she was terrified. She might well be 
disturbed at the convulsions, for besides interfering with 
her work which was that of a dress-maker, she had broken 
her hands twice, and while subject to the convulsions she 
was almost always bruised from falls. In a convulsion she 
thrashed about so, it took several men to hold her. She was 
a large-framed woman, nearly six feet tall, bony and mus- 
cular, but with a small, pretty and innocent face, like that 
of a young girl. 

The vomiting was serious too, for even when she was 
not nauseated, her stomach automatically "turned over" 
and emptied itself, as soon as anything was taken. The 
patient was known to be an hysteric, and her convulsions 
and vomitings had been already diagnosed as hysteria, and I 
■^ad been told also that when she was about ten or eleven 
s\ve had suffered for a year from what was then called, "St. 
V itus Dance." 

I saw the girl first, for a preliminary interview, January 
24, 1912. At this time she told me about her vomiting 
and convulsions and how she had recovered, before, at her 
mother's death. She said she had not known even of her 
mother's sickness till told of her death. This was a great 
shock to her, for she was absolutely bound up in her mother. 
She now felt she must take care of her brother and so she 
determined to get well. Whatever the determination had 
to do with it, she did start gaining, right off, and was dis- 
charged, in just two months, the convulsions having ceased. 

At the second interview, January 26, the girl described 
more fully her feelings as following: "It's like a cloud — a 
blue feeling hanging over me. This cloud feeling came on 
in the summer. I didn't want to go to any place. Things 
I used to like to do, I didn't want to do. I feel like sleeping 
all the time, yet when I go to bed I can't sleep. I some- 
times have the feeling I am walking in space; everything 
becomes blurred; I can't seem to bring myself to where I 
am. When the spells come on," she continued, "I can't 



L. E. Emerson 387 

seem to keep my head about me — I go off, dazed, — I don't 
know anything." 

The first convulsion occurred when she was about 
eighteen or nineteen. She attributed it to a "bad-test." 
She was a telephone operator, at the time, and was very 
nervous. "I was nervous before that, though," she said. 
"At school I was nervous; my imagination was big." 
Then she went on to tell me that in the seventh grade, 
when she was about eleven, she was taken down with "St. 
Vitus Dance." "I was in bed some months," she added. 
"They said I was out of my head. After that I remem- 
ber trying to do things and couldn't — shaking." 

"Were you ever frightened as a little girl.^" I asked., 
"Yes," she answered. "I've had men chase me; fire; like 
everybody else." She told of being chased twice: once when 
about seven; and when about fourteen. But she had not 
been seriously frightened. 

When asked how she slept, she said, "poorly." "I 
went to bed last night about eleven, but I couldn't sleep, so 
I got up at about one, and went down stairs. I stayed till 
four." She had dreamed last night; it was a "troubled" 
dream. "It seemed to be some place — I didn't want to be 
there. I was trembling all over — I often do that." That 
was all, however, she could remember. 

At the next interview, which was Monday, January 29, 
she told of her intense antipathy towards her father. 
She said she had always felt badly towards her father. 
She wouldn't go to him as a child. She could remember 
how she hated him when she was five. Her mother told 
her it was so, she said, when she was three. Then she told 
of discovering that her father was not faithful to her mother. 
She was sixteen when she knew the terrible truth. "I fol- 
lowed him one night," she said. She followed him several 
times afterwards, she added, and corroborated, to her own 
satisfaction, her suspicions. 

At our next interview, which was Tuesday, January 30, 
the girl told me that her father had accused her of killing 
her mother, through worry, etc. 

Friday, February 2, the girl returned. She was feeling 
very badly. She said she hadn't slept the night before 



388 A Psychoanalytic Study of a Severe Case of Hysteria 

more than an hour. She said she didn't wish to live, and 
added "I wish there was no such thing as life." 

"Is that on account of your father.^" I asked. "I 
suppose so," she answered, "I never used to feel so." Then 
she told me she had had another convulsion Wednesday 
night at 6.30 o'clock. At supper her father had asked her to 
go to the Wednesday-night prayer-meeting with him. She 
said she thought he was a hypocrite. While washing dishes 
she was thinking about it. "I didn't feel as though I 
wouldn't go," she said, "I was thinking whether I would go 
or not. I didn't really want to go, but I thought, if I can 
get ready I will." 

It hardly seemed possible that her feeling against her 
father could be strong enough to cause a convulsion, yet in 
lieu of a better lead I followed that. She said she remembered 
when she was fifteen or sixteen, seeing her father strike her 
mother. "I couldn't believe it for a minute," she said, *'I 
felt awfully bad. I think it was right after that that I grew 
suspicious. I didn't know anything about badness between 
man and wife, but when I found it out, I surmised where 
his money went to." 

"What do you know about badness between man and 
wife.^" I asked. She said, "the girls let it out." Sex 
knowledge shocked her, because she had thought the 
father-mother relation purely spiritual. When she first 
heard this she hardly spoke to her mother for a year. "I 
blurted it out to her one day," she said, "and after that I 
got over it. She said I ought not to feel that way, that was 
the way people did." But talking about these matters 
does not relieve her. She says she feels as though a cloud 
hangs over her all the time, as though some awful news were 
coming; something awful going to happen. 

At the next interview the patient informed me that she 
had had another attack the night before, which had lasted 
three-quarters of an hour. She knew for a second that it was 
coming, then everything went dark. She had been sick in 
the afternoon and vomited and had been unable to eat any 
supper. She said "It seemed as if something were thrown 
over my head, and I couldn't see anything." This attack 
also had occurred at about supper time. Knowing her 



L. E. Emerson 389 

feeling against her father, and assuming her nausea to be 
perhaps a sort of moral disgust at his sexual misdeeds, and 
hypocritical religiosity, I asked her if the nausea had not 
come from having to sit at the table with him. She said 
it had felt that way. But while moral disgust might lead to 
nausea. It certainly was no adequate reason for the con- 
vulsions which followed. To find an adequate cause for that 
I must search much further. 

She told me of two lovers, one of whom she had given 
up, for the sake of the other, who, however, had died. She 
had never gone back to the first lover. On questioning her 
as to her first knowledge about sex she said, "It used to 
make the shivers go over me. Mother spoke of my loss of 
appetite, but I don't remember that I was nauseated." 

I did not see the girl again till Monday, February 12. 
She told me that she had had another attack the day before 
at ten o'clock in the morning. Her father and her brother 
were home. She had had a dazed feeling with the "spells," 
as if her feet were not on the floor. When she came out* of 
the attack she couldn't speak and did not regain her voice 
until eleven at night. She was now afraid she was going to 
lose her voice again. She first lost it when the "spells" 
started. This was the time she began to be worried, 
too. 

I asked if she could remember anything she was es- 
pecially worried about at this time. She said she was 
worried about her relations with Dick. (He was the one 
who died.) "I didn't go with him openly," she continued, 
"mother didn't want me to go with him, she didn't think he 
was a good fellow. She knew I met him at times In the 
street (father had forbidden me to bring him to the house), 
but she didn't know how much. I only went with him 
about six or eight weeks. It was about three weeks later 
that he died. It broke me up for quite awhile." 

"Was he not really all right. ^" she was asked. 

"I don't think he would have been all right If the girl 
hadn't been all right," she replied, but he was full of fun, 
and I had a good time with him. He fascinated me when I 
was with him. I looked for him; but once he was out of 
sight, I didn't feel the same." 



390 A Psychoanalytic Study of a Severe Case of Hysteria 

"Did he ever take any liberties with you?" I asked, 
"or insult you?" 

"No," she answered. "I was always on the watch be- 
cause they said he was not a good fellow." 

"How often did you see him?" 

"I met him sometimes every night," she said. She then 
told me that he was a traveling man and away a good deal 
of the time. 

"I don't think I would have gone with him at all," she 
continued, "if father hadn't forbidden it. I tried to see 
how far I could go and not have father know." 

"And his death was a great shock to you?" 

"No, I was rather glad; I felt relieved." 

"Why?" 

"Well, I had already thrown him over before he died." 

"What made you throw him over?" 

" We quarreled. Mamma was at grandfather's funeral; 
Papa was away; so I sent word that the house was clear. 
He came and stayed to supper. He wanted me to make 
him something for supper and I wouldn't, so he got mad. 
I had some of my girl friends in to supper, too, and afterwards, 
when we were playing games, he refused to play with me as 
a partner. Besides, I saw him cheat. So when he went that 
night, I told him he needn't ever come again." 

About a month later he died, rather suddenly, and 
about' four months after his death she had her first at- 
tack. 

She had another significant dream, the night before. 
"I dreamed," she said, "I was in to see you again. You 
were trying to find out things. It seemed all the time as 
if I were afraid you would ask me something, but I couldn't 
think what it was, when I woke up." 

The girl returned the next day, February 13, and said 
she had had no attacks. She had dreamed, the night before, 
that she was married to " that Dick." She had also dreamed 
the "old dream." "It seemed as if I were running away 
from somebody or something. I would stumble and ge tup 
, and stumble. But it didn't seem as if anybody ran after 
me." She continued, "I have not had it for a long time but 
I used to have it often." She has a dream which she can- 



L. E. Emerson 391 

not remember, but when she wakes she feels sick and is 
shaking all over. 

The next day, February 15, the patient reported that 
she had had that awful dream. 

I had the patient give me some free associations. After a 
long wait she said, " I can't tell everything that goes through 
my mind. I can't put them in words; I'd tell them if I 
could." 

"You can tell if you will," I asserted. 

"I can't," she said, "it just seems as if my throat were 
all closed up. They just go through my mind, but I just 
cannot speak them." 

"What is it you see.?" I urged. The patient was sitting 
with eyes closed. 

"It seems as if I know, yet I can't speak it," she said. 
"It seems as if that dream were right back." 

"Which dream.?" I asked. And then we found that the 
dream was partly of her mother. She stood and was telling 
her not to tell or remember something. Her mother stood 
in front of the "cloud" and kept it from coming nearer, so 
she could not see behind it and tell what it concealed. 

Three or four times she tried to get by that cloud and 
each time her mother stood in the way. Once she saw her 
pointing her finger at her. Her emotion was very great. 

The next day, February 16, she said she had had another 
attack, and had hardly slept all night, till five, when she 
slept about half an hour. She had had no dreams. I 
asked her about her mother. "I keep thinking," she an- 
wered, "she wouldn't tell me not to tell anything." "I 
keep thinking back over my life to see if there is anything 
she could have meant." 

"Tell me," I urged, "what it is that is troubling you." 

"I wish I could tell," she replied, "it seems as if some- 
thing kept going over me but I can't tell what it is — a 
thought and feeling both." 

(The patient was sitting with eyes closed.) "What do 
you see now.?" I asked. "I didn't get anything," she said, 
"only those old thoughts." 

"What thoughts.?" "I keep thinking I am not a good 
girl. It was as if a screen were opened for a moment; as if I 



392 A Psychoanalytic Study of a Severe Case of Hysteria 

did see it for a moment, but couldn't. If I could only make 
myself, but I can't." "It looks as if something were being 
concealed," I said. 

"I didn't think there was, but it seems that way," she 
answered. "It seems as if my mother were standing in 
front of something looking down at me in scorn." 

" What for .? " I asked. " I don't know," she said. 

"Did some boy assault you .^" I continued. " It couldn't 
be," she cried, "it can't be. But in that cloud she stands 
so condemning — like that something must be. It seems 
as if I might have been insulted, I don't know." 

Monday, February 19, when I saw the patient next, 
she told me she had three attacks Saturday, but had slept 
splendidly Saturday night, and felt well all day Sunday. She 
dreamed Sunday night that she was in the woods. She 
seemed to be lost, and was running away from something. 
During our interview, she remarked, "It seems as if there 
were' something I mustn't tell. It seems as if there were 
something there, but I couldn't tell it. Something seemed 
to flash over me and said, don't tell. It seems more like a 
promise, as if my mother were over me." 

I asked her to close her eyes, and tell me what she saw. 
"Oh, I never can do it," she cried. "It seems a perfect 
blank and I have not got the courage to look. It seems 
that if I did the cloud would come." Despairing of ever 
being able to persuade her to look voluntarily, I put my 
hands over her eyes, and told her to look and tell me what 
she saw. 

She sees a man; she sees herself; she is about eight 
or nine. She finally recalled that it was a neighbor. She was 
about thirteen. 

She then had a slight attack, and was rigid, with eyes 
closed, but soon recovered. She felt terribly at the ap- 
parent corroborations of our suspicions. At first she re- 
fused ever to come back, but finally promised to return 
the next day, and kept her promise. On her return, she 
reported that she had not slept all night, but had had no 
attack; she had eaten nothing, however. 

I pointed out the fact of sex running through every- 
thing; but made her responsibility in the whole matter seem 



L. E. Emerson 395 

as little as possible. While she acknowledged it all it did 
not seem as though she were relieved. She still felt the 
cloud. 

I put my hands over her eyes. 

She saw the room again. After a while she saw woods. 
Her mind went from woods to room. In the woods she was 
about nine. She was running; she stumbled. She got up 
and ran on. She kept stumbling, and getting up, and run- 
ning. At last a man caught her just as she stumbled. 

Then her mind turned to the room. In the room she 
saw the neighbor again. 

All this time I held my hands over her eyes. She 
writhed terribly as she was telling this. But she did not 
stiffen as she did the day before. She said she felt as 
though she had promised not to tell. It seemed as though 
she couldn't live. 

When the patient returned, Friday, she reported she 
had had two attacks. On coming out of her attack Wednes- 
day, her left hand was clenched, and she couldn't get it open 
till ten o'clock Thursday morning. She also had trouble 
walking up stairs. Her knees felt weak. She was in a 
dazed state a good deal Wednesday and she was unable to 
remember what she was thinking of. 

I put my hands over her eyes again. She was now able 
to tell me more about the assault in the woods. But there 
was still a cloud. I insistently urged her to look. Suddenly 
she became stiff, and when she recovered, her left hand was 
clenched and both legs paralysed. She said that suddenly 
it went from her head to her legs. Being now paralysed 
she was admitted to the hospital. 

I asked her what she saw in the cloud and she said, 
"Dick and mother." 

It is interesting to note this transformation of the symp- 
toms. During the interview the patient had every ap- 
pearance of being about to have a convulsion, but instead of 
that she became paralysed. It was as if something were 
trying to come to her mind but could not get in, and was 
crowded instead into her legs and hand. Whatever hap- 
pened, it carried with it a complete loss of voluntary control. 
The hand was clenched, about the thumb, and could not be 



394 A Psychoanalytic Study of a Severe Case of Hysteria 

opened; the legs hung limp, flexible and utterly powerless; 
she could no more stand on them than if they had been tape. 
What it was, however, that flew from her head, and took 
refuge in her limbs, she did not know. Her nearest de- 
scription was that it was a "cloud." 

What that "cloud" concealed was now the object of 
our quest. 

But before we start on that search, let me first say a 
few words about what has already been accomplished. 

We have uncovered a psychic trauma. The assault in 
the woods was sufficiently serious to serve as a psychogenic 
nucleus for a psychopathic process. 

Here is a reason for the recurrent "old dream," in 
which she ran and stumbled and picked herself up and ran 
on stumbling. Here is one reason for feeling that "some- 
thing awful" had happened to her. Here is a reason for 
dreaming she was in the woods running away from some- 
thing. Here is a reason for feeling she had hidden something. 
She had hidden this thing. She had never told anybody. 
And here is an adequate reason for the so-called St. Vitus 
Dance, which followed in a few months. Here, too, we may 
see the origin of the patient's strong feeling against sex. 
But the release of whatever repression that had resulted in 
the crowding out of consciousness of the memory of this early 
event, was not sufficient to afford any apparent relief. 
Much. still remained to be done. 

When I saw the patient the next morning she said she 
had slept better during the night than at any time for a 
long while. She had had no convulsions; neither had she 
been nauseated. 

Of course Dick was the center of further suspicions. 
At my insistence she remembered and reproduced many 
scenes with him. But she could remember none * of any 
especial significance. 

I put my hands over her eyes. 

She saw Dick (looking all right) ; mama (looking scorn- 
ful); papa (laughing). 

She couldn't get Dick off her mind, but saw and remem- 
bered nothing of importance. 

Monday, when I saw the patient next, she told me she 



L, E. Emerson 395 

had slept well and had had no attacks and no nausea. She 
had dreamed of Dick, but could not remember what. 

She was fifteen when the girl at school told her about man 
and woman. At the time she grew weak and felt faint, and 
some girls seized her to keep her from falling. She had to 
stop at a friend's house before she went home. She never 
went back to school. Her knees have troubled her ever 
since. She said, "they felt * rolling. '" She continued, "I 
don't think I ever thought of it, except I felt awfully when- 
ever I saw the man." 

The next day, when I put my hands over her eyes, she 
saw Dick and she saw her mother; she thought of the warn- 
ing she gave her. Then her mind turned to the woods; 
then she saw the neighbor; then back to her mother and to 
Dick. She said "It seems to me that if I ever knew Fd 
never have any peace. It seems as if Dick, mother, father 
and I, were in the cloud. It seems to me that if I told it, 
it would be as much as my life to tell it." She said Dick 
and the neighbor seemed fused at one time. She sees the 
room at another. (When the neighbor attacked her she 
remembered he had choked her, etc., but she knew of nothing 
else.) She goes through the scene in the woods again, but 
not so vividly. She seems to be sick and Dick is kneeling 
and holding her hands. Her mother always stands in front 
of the cloud, and keeps it away. She fears lest her mother 
return to haunt her if she tells. Her mother forbids her to 
tell. She ends the session by saying "Dick seems to be 
asking mother if he may take me to the woods, and I am 
afraid to look for I know something awful will happen." 

The next two days yielded little in the way of tangible 
results. But Friday, March 1, she said, "I am afraid I 
yielded to Dick." 

"Would you not be willing to look and see if it isso.^" 
I asked. 

"I could look at it to get my feet," she said, "but I 
never could before." 

Twice, by putting my hands over her eyes, I tried to 
help her look, but both times the vision of her mother pre- 
vented. Once she seemed almost to push her mother away, 
and afterwards felt remorseful, but to no purpose. At one 



396 A Psychoanalytic Study of a Severe Case of Hysteria 

time she did see Dick and her mother talking, seemingly 
about her — Dick was cross and angry. Always it is the 
vision of her mother that stands between her and the knowl- 
edge she is seeking. Saturday, she said, "ever since I broke 
off with Dick I have thought of him. But no one ever 
knew it. I wish that he had never come in my life at all or 
he had lived and I could have had him." 

Monday, she said, "I am all the time dreaming about 
Dick." She tried to stand but was absolutely helpless. 
Her hand remained contracted. Tuesday, she stated that 
the preceding night when she would lie down she would 
have an awful feeling; she would stand it awhile, and then 
it became like an external force and she would fly out of 
bed. 

I put my hands over her eyes. She struggled terribly, 
but finally saw mother, Dick, and two beds. She couldn't 
see what was in one of the beds. Her eyes seemed strangely 
blinded. Wednesday, she showed, for the first time, a real 
emotional melting. She cried, and the hardness of her chin 
broke into quivering. Thursday, she said, "I am thinking 
all the time of the same thing. It seems as if it can't be so, 
even if I see it. It seems as if somebody wouldn't let me 
know." 

I then put my hands over her eyes. She remarked, 
'*It is just as if I had my eyes closed and wouldn't look." 

"Try to look and know," I urged. 

"I will try till I do conquer," she declared. "It seems 
as if I could know, but when I try I can't." 

Friday, when I held my hands over her eyes, she had a 
very significant series of visions.^ She saw herself lying on 
the floor. Then she went on, "Now Dick is leaning over 
me. Now there are other people coming in. It seems that 
if I could look I could know. It seems as if mother were 
trying to make me look, but Dick wouldn't let me. If 
mother came around it must be Dick who is keeping me 
from it." 

Then Dick was leaning over her while she was lying 
on the floor; it seemed as if he had her hands, and as if he 
were trying to hold his hand over her mouth so she couldn't 

^ See second part. 



/,. E. Emerson 397 

tell. He seemed to be trying to prevent her looking, too. 
Twice I tried to help by holding my hands over her eyes, 
but both times she was unable to look. 

Monday, March 11, I had her lie back in her chair. 
While reclining she gave me many associations, mostly about 
Dick. She described minutely the last day he was at her 
house; the pulling her down on the sofa; giving her a kiss; 
quarreling that night; telling him she didn't want to have 
anything more to do with him, etc. She thinks that it 
can't be that she actually yielded to Dick because if she had 
she wouldn't have felt so badly at giving him up. (She had 
had hard work to decide to do so.) And the feeling of relief 
she experienced at his death, she thinks was due to the 
feeling that now a real temptation had providentially been 
removed. 

When I saw the patient again, the next day, I had her lie 
back in her wheel chair, close her eyes, and tell me what she 
saw. 

After speaking of several things of relative unimportance, 
she said she saw the man who assaulted her when she was 
thirteen. In the picture before her mind, he had her on the 
floor. Suddenly she started violently, and I asked her what 
happened. 

"Oh," she exclaimed, "I was just thinking of him and 
it seemed as if his face came right up to mine." She then 
went on to tell how badly she felt whenever she saw this 
neighbor. 

This man comes occasionally to visit her father. The 
last time he was at the house she had to go for milk and he 
went with her. She felt terribly, and when she got home 
she was so weak she could hardly stand. Yet at that 
time she was not conscious of any reason for her feeling. 
Here then is a striking amnesia. Such an exciting experi- 
ence for a sensitive girl of thirteen, as being thrown to the 
floor, by a neighbor, whom she disliked, to whom she had 
been sent by her mother, probably on some trivial errand, 
would not normally be easily forgotten. She would natu- 
rally remember how she picked herself up afterwards and 
got home. Here, then, is a problem. 

The next morning, when I had her lie down, as before, 



398 A Psychoanalytic Study of a Severe Case of Hysteria 

I questioned her as to this. She answered, "of course I 
know there is more, really, but I can't seem to get it." 

She remarked, "Dick's face comes and fades away into 
somebody else's." She was unable to recall anything more, 
however, even after the most insistent urging, about the 
man who attacked her when she was thirteen. 

When I saw the patient the next morning she stated 
that she had dreamed that a doctor had asked her why she 
didn't tell about the time when she was thirteen. I had 
her lie back in her chair and close her eyes. She reproduces 
the scene of the attack, as before. Then, as nothing further 
seemed to come, I put my hands over her eyes. She sees 
herself struggling with this neighbor. 

While she was reproducing this she had the "troubled 
thought," and went on to say, "he would make me feel 
weak and faint and my head would ache and I would feel 
weak all over. But I didn't know why till I remembered 
the assault the other day," While I had my hands over 
her eyes she saw the neighbor, the room, and herself on the 
floor, but she could get no further. This time there was no 
interference by any vision of Dick or her mother. 

The next morning the patient informed me that she had 
thought a great deal about the time when she was thirteen, 
but got nothing. It all seemed a blank. But, she said, 
now, this man and the cloud seem identical. 

"Was it really so .^" I asked. " Is it not all imagination .? " 

She asserted that what she saw yesterday was really so, 
but beyond that remembers nothing. I put my hands over 
her eyes. She sees the same scene. Each thing that she 
sees she remembers was true, but she can get nothing in her 
memory which was not forced by my hands being over her 
eyes. 

The first thing when I saw the patient the next morning, 
Saturday, March 16, I said to her, "Can you not think of it 
as of a game yet.'"' 

"It's no game," she replied, "of course I know it is true, 
I know that but I hope that it isn't." 

Yesterday, she stated she could remember the attack 
better. It wasn't so much like a dream. "You couldn't 
get anything more yourself.^" I asked.- "Of course I can 



L. E. Emerson 399 

imagine it," she answered, "but I can't remember anything 
more at all." 

Monday, she remarked, "Yesterday, I thought and 
thought; it seemed as if I thought of nothing else all day, 
yet I couldn't get it; yet there seemed more." And when 
after a morning of fruitless effort I asked her if she didn't 
feel sorry at our lack of success, she replied, "I don't know 
how I can feel sorry when I know perfectly well there is 
something more and I can't look at it." 

Tuesday she said she thought things over but didn't 
get anything more. 

Wednesday, the patient said she remembered it was all 
as she saw it yesterday. "It wasn't imagination.^" I said. 

"Why no," she declared "I remember it happening." 
To-day, while I had my hands over her eyes, she got a little 
more. But she exclaimed, pathetically, "I can't help think- 
ing there is some way out of it. ' Isn't it enough that I know 
it," and choked back crying. As has been said before she sel- 
dom cries. She didn't cry even at her mother's death. 

Thursday, she said she remembered that what she saw 
yesterday was really so. She said, "I just thought till it 
seemed I didn't have any thinking powers left to think with," 
and added despairingly, "I can't help thinking he didn't do 
it. I don't remember anything more, it is all a mystery to 
me." 

Friday and Saturday brought little advance. Friday 
she said, "it seems as if my mind goes to thinking something 
and stops right short." Saturday she remarked, "if I 
could tell and not know I was telling, but I really know all 
the time!" She continued, "I don't see anything but 
just what I actually know, now; I can't get my mind oif it. 
I know it must have been so — I realize he must have, but I 
can't seem to think of it as I do the first part of the scene; 
it seems as if I really knew that." 

Monday, March 25, during some free associations, the 
patient thought a good deal of Dick; she thought of the 
woods, too. She said, "I was thinking of the woods — 
how I got home that time — it seemed as if the last part of 
that were gone too — the dream of Dick, too, keeps coming 
to me — all the time I know I am thinking of something 



400 A Psychoanalytic Study of a Severe Case of Hysteria 

but I don't know what — I think of the room; but there 
seems to be something else I keep thinking of — it 
seems so separate from the room that I was wondering if we 
got that, if there were anything else we would have to get^ — 
it seems as if I were thinking and then everything goes blank, 
just as if my mind stood still." 

Tuesday, during some free associations, she said, "it 
seems as iflthinkof Dick just as soon as I think of the room." 
Continuing, she said, "when I keep my eyes shut and am 
lying down it seems as if I were there. I think of the two 
rooms, I mean the two places — room — my feelings at the 
time — oh! when I get my eyes shut I am going through it 
again — times, mo.ther, room and woods — I was just think- 
ing of it — I keep going over it and over it and over it all 
the time — my mind is right on it all the time, switching on to 
the two parts of the two scenes — if there was anything differ- 
ent I wouldn't mind so much, but it just stays on the same 
thing — etc. I know I feel I am keeping something back 
but I don't know what it is; it seems to be right in my throat 
only I can't get it out — just as if I wanted to tell something 
and couldn't." 

The next week showed no apparent advance. 

The next two days showed little advance. Monday, 
however, she said that last night she got her hand part way 
open. It was about one o'clock, a.m., she was lying on her 
back, and for a moment knew the end. At that moment her 
handopened and then her mind went to her hand, and it closed 
again. She said, despairingly, "I don't know it now at 
all." She continued, "afterwards it seemed as if I knew it 
and yet I did not know it; just as when you know a person's 
name, and have it right on the end of your tongue and can't 
say it." 

The next day she said she had dreamed of Dick. "It 
seemed as if he wanted me to do something but I couldn't 
doit. The nurse told me I said, 'I can't doit, Dick.'" Dur- 
ing the next two nights she again dreamed of Dick. In 
the last one she explained, " he was home and I was there and 
he kept asking me to do something. I was troubled. 
Mother came in and said it served me right for going with 

^ See second part. 



L. E. Emerson 401 

him. I was crying In the dream." Friday she dreamed she 
was studying to be a nurse. Saturday she said she had 
always wanted to be one. "I wanted to be eighteen so I 
could be, but when I was that age my parents said I couldn't. 
The following Monday, April 15, our persistent efforts were 
rewarded. 

While lying back in her chair, with her eyes closed, 
she said, "y^-f, / know it,^^ and as she said this, her hand 
opened, and she put it to her head in most dramatic fashion. 

She said she remembered the neighbor doing it, then 
leaving her, and shutting the door. Further than this she 
does not remember. 

Here, then, is a second psychopathological nucleus, the 
result of a psychic trauma, at last actually uncovered, and 
with the realization of it the clenched hand opened. It was 
as though that hand had held a secret. Some measure of 
the resistance felt by the patient against remembering the 
trauma is indicated by the time and effort it took to get it. 

Contrary to what we might expect, the actual realiza- 
tion of the dreaded recollection did not result immediately 
in the release of all resistances. 

Not until the memory of what happened immediately 
after the assault, came back completely, did the paraplegia 
disappear. 

The conscious content of the patient's mind, while 
rigidly excluding the traumatic material, has been partly 
pictured. The subconscious content of the patient's mind 
can, of course, be only remotely inferred. One naturally 
infers subconscious mental processes closely analogous to 
conscious ones. Consciousness seems like a visual field, 
focused to be sure, but surface-like. Mind, however, has a 
depth, another dimension, a dynamic character, that sur- 
faces seem to lack; it is this third dimension, this dynamic 
character, of the mind, which is properly dubbed subcon- 
scious. 

Roughly, for practical purposes, Freud conceives of 
the mind as possessing three layers. In the "conscious" 
level are all those things one is actually aware of at any 
given moment; in the next lower level, the "fore-conscious," 
are all those things immediately available, as memories, for 



402 A Psychoanlaytic Study of a Severe Case of Hysteria 

any ordinary occasion; in the next lower level the sub- 
conscious, are all those things, once memories, now recover- 
able, however, only under special conditions. 

It is obvious that instead of speaking of three "levels," 
an infinite number of "levels," is nearer the truth; as a 
block may be said to be an infinite number of infinitely thin 
sheets. In this third dimension of the mind, attractions and 
repulsions are the essentials of the situation; in psychological 
terms, ''likes and dislikes," or *' cravings and disgusts." 

In the patient, owing to her early experiences, her 
sexual cravings were highly intensified. In her conscious 
life she sought to be free from any such incroaching cravings, 
disturbing her desire for a "pure" life; hence the conflict, 
resulting in the repression. That part repressed, however, 
being highly dynamic, resulted in explosions; hence the 
convulsions. Convulsions being almost equally distressing, 
the rising flood of energy is fought off, and voluntarily re- 
pressed, and hence the splitting of consciousness, resulting in 
the loss of voluntary control of lower centers. This splitting 
was rather of a "horizontal" sort, then surface cracking; as if 
the patient had cut loose from moorings and had risen, so to 
speak, as in a balloon, to where she no longer had any control 
ov^er what went on beneath her. When she came back to 
earth, or perhaps raised earth up to her, she was as one 
landed in the dark. She knew she was safe, but she didn't 
know where she was. She had now to work her way through 
more resistances, till she could regain a relative control over 
what she had cast off from her. 

When I saw the patient the next day, April 16, I asked 
her why she had not had a convulsion instead of being 
paralyzed. She answered, first, because she didn't want 
to have one before me; and second, because she was so afraid 
if she did have one, the doctors would stick pins in her, to 
test her, as they did before. When they stuck pins in 
her, and stuck their nails in under hers, she said she didn't 
perceive it at the time, but afterwards it would pain her 
terribly. Her hand was all right, but she was still paralyzed. 
She could remember nothing else. 

Wednesday, when I saw the patient, her hand was still 
apparently well, but she said it had been clenched a little 



L. E. Emerson 403 

while during the night. "I suppose I was dreaming about 
the assault," she said, "but when I woke up I put my mind 
right on it and got my hand open. I just thought I couldn't 
help it anyway and I was bound to get my hand open." 
She further said that ever since she had "St. Vitus' Dance" 
she had had trouble with her legs. At that time she couldn't 
walk at all. When the girl told her about sexual matters, 
when she was about fifteen, she almost lost the use of her 
legs and they thought she was going to have "St. Vitus 
Dance" again. 

Thursday and Friday we got nowhere. Saturday she 
said she had dreamed she was home, sick-abed, and her 
mother was there. "I was a child; I kept saying, 'mother, I 
can't tell,' and she kept questioning me and wanted to 
know what was the matter. It seemed as if I would start to 
tell but couldn't. I would make out there wasn't anything." 
Then she had another dream. She had a box of chocolates 
and dreamed she was concealing it. ^ Woke up saying, "that 
isn't the right thing." 

Her hand has not shut up since. "It doesn't feel 
natural yet," she said, "but it is getting better every 
day." 

Monday she says her hand feels like tightening up but 
she can get it right out again. She is in a very ugly mood. 
She said, "I feel like getting up and stamping and scream- 
ing. ... I just feel that I don't want to see it and I'm 
not going to. ... I keep thinking that I shan't look and 
I can't get my mind to think that I will look." 

Tuesday she thought Dick may have done wrong to her.* 
Wednesday, Thursday and Friday showed no advance. 

Saturday the patient remembered being home after the 
assault, in bed, sick. Her mother asked her what was the 
trouble, but though she knew she would not tell. "She 
would ask me what I did over there. She asked me what 
made me so long. I don't remember just how I answered, 
but I know I evaded her questions." 

Monday, April 29, she said she had moved her leg the 
previous day. She was trying to think how she got home 
and something came over her and she moved her right leg. 

^ See second part. 



404 A Psychoanalytic Study of a Severe Case of Hysteria 

Tuesday showed no gain. Wednesday she said she had 
moved her leg again. (She had been trying to do so and had 
relaxed.) I had her lie back and close her eyes and try to 
remember the gap between the assault and being home in 
bed. She could get nothing but a vision of her mother. 
She said, "I feel mother has something to do with my not 
telling." 

Thursday, May 2, while lying back with her eyes closed, 
she suddenly said, "I know." 

When she had told this she moved her legs slightly. 
She continued, and said that he took her home to the gate. 
She staggered along the path and crawled up the back steps. 
When her mother let her in she sat in a chair in the kitchen 
awhile and then went to bed. 

Friday, May 3, the patient can lift her right leg but 
not her left. She cannot stand as yet. She remembered 
further details. 

"Didn't you tell your mother.^" I asked. 

"I have the feeling I told her," she said. "It seems as 
if I got up and went down stairs. I remember being on the 
couch. His wife came in and was questioning mother about 
it. It worked me all up to see her. But mother said it 
was all nervousness." 

After a long pause, she exclaimed, "I know, I told 
mother. She said people thought things so much they 
finally got to think so in reality. She wouldn't believe me." 

The patient can move her left leg now, but cannot 
stand. Saturday she stood a little but was wobbly. She 
said that it was hard to tell her mother but when she had 
and wasn't believed, she shut right up. 

"It seems as if every time I spoke of it mother pooh- 
poohed it, and said I had dreamed it, till finally I thought I 
really had dreamed it. I remember seeing him and I 
thought of it, but I thought of what mother had said and 
I tried to put it out of my mind. Just how long it took I 
don't know." 

The first time she saw the man again was about a week 
afterwards. She was sitting on the piazza with her mother 
and he and his wife came over for a few moments and sat 
with them. As they were coming up the path her mother 



L. E. Emerson 405 

gave her a look as much as to say, *'you stay." She did so, 
but was so weak and faint she felt if she should stand up she 
would faint away. She didn't speak and never looked at 
him when she could help it. She was trembling all over and 
felt sick. After that she saw him as usual and finally her 
memory of what he had done, went. It kept getting fainter 
and fainter until it had gone completely. It seems it must 
have taken her about three months to forget the incident. 

Improvement during the next few days was rapid. 
Wednesday she was walking about the wards alone. Tues- 
day night she dreamed something, "but," she said, "I can't 
tell what. I woke up saying 'I shan't tell anything more."* 
Friday she said she had dreamed another distressing dream. 
"I was walking and somebody kept bringing up different 
reasons why I shouldn't walk, but I kept on." The reasons 
were like pictures. "It seemed like a woman standing in 
front of me, showing these pictures, and then saying, 'now 
you can't walk.' I woke crying. I thought of mother." 

She continued to gain, however, and was discharged 
from the hospital May 11, apparently recovered. 

Now we can understand the meaning of the interference 
of the image of her mother with the recovery of this second 
submerged complex. With a cowardice almost incredible 
her mother had refused to believe her story and had done 
her best to help her crowd it out of her mind. 

This repression was no instantaneous affair, however, 
but was a matter requiring months. Probably if there had 
not been already repressed, a nucleus of the same sort for 
it to attach itself to, repression at this time would have been 
impossible. But there was a successfully deeply buried 
sexual complex already existing in the subconscious which 
coalesced more or less with the more recent, and even more 
distressing, experience, and helped to keep it under. That 
these two experiences had coalesced in the subconscious is 
made probable by the fused fashion in which they first 
partially presented themselves to consciousness at the be- 
ginning of the analysis. With her mother's help, then, and 
with the complex already there waiting to welcome a similar 
companion, a further repression actually was achieved. 
But the price paid was rather high. When, about two 



406 A Psychoanalytic Study of a Severe Case of Hysteria 

years afterwards, a girl happened to speak lightly, as school- 
girls will, of a sexual topic, she was so abnormally sensitive 
to any mention of anything sexual she became sick, and on 
that account left school for good. 

Furthermore, it started her on a still hunt after her 
father. It is highly probable that her suspicions as to his 
faithfulness, too, were untrue, being based on insufficient 
evidence. True or not, however, she believed her father 
bad in a sexual sense, and hated him accordingly. And in 
addition to all this she could not feel for her mother, much 
as she loved her and was dominated by her, that respect 
necessary for satisfactory family relations. 

In one very important respect, both her father and 
mother were unable to control her. In her desire to go with 
Dick, a questionable character, she absolutely defied them. 

One could imagine that her convulsions, which started 
a few months after Dick's death, were the immediate result 
of dreaming about him, with a pathological power possible 
through releasing the pent up energy, so to speak, of the 
repressed sexual complexes. One could conceive the 
mechanisn; of this as being both physiological and psycho- 
logical inasmuch as the lower centers might be conceived 
as disassociated, and so released from this inhibiting power of 
the higher centers, and psychologically as being due to 
sub-conscious, dream-like desires, which acted like a match 
to gun-powder. That was the view taken, and the progress 
of the patient seemed to justify it. The recovery, however, 
was only apparent, except for the worst symptoms, the con- 
tracture and the convulsions which have never returned, but, 
as we shall see, there were other repressions which remained 
to be released, and which manifested themselves in symp- 
toms, the clearing up of which will be reported in the next 
paper. 

{To he continued,) 



PSYCHOGENIC DISORDERS IN CHILDHOOD^ 

BY TOM A. WILLIAMS, M.B., CM. (eDIN., WASHINGTON, D.C.) 

Corresponding Member, Society of Neurology and 
Society of Psychology of Paris, etc. 

IT is remarkable that amidst the abundant psychological 
study of the development of children so little attention 
has been paid to those factors of abnormal reactions 
which are psychogenetic. The invocation of hered- 
ity, period of growth, reflex irritation, etc., has been too 
ready. The "nervousness" postulated has been called 
hysteria, chorea, neurasthenia, and what not, without real 
search for its origin; for the generalities indulged in are, 
when analyzed, explanations of no meaning, showing only 
the vagueness of the observers' conceptions regarding patho- 
genesis. Even the photographic minuteness of a Janet 
failed to take account of the psychopathology of a child; 
for he went the length of declaring that the synthesis he 
called psychasthenia could hardly occur below the age of 
eight, and was rare in children at all. 

Even now that serious analysis of adult cases is finding 
that the origin of psychoneuroses can often be traced into 
childhood, it is remarkable how few observations of neurotic 
children themselves have been made. It is in order to con- 
tribute to the filling of this gap in psychopathological data 
that this contribution is made. 

It is the more especially pertinent in that in the cases 
observed I have not discovered the aetiological factor of the 
type so often referred to as essential by many psychoanalysts. 
The affective situations which have promoted the psycho- 
logical perturbation of my patients do not appear to have 
been connected with the psycho-sexual relations, but, on the 
contrary, to have been the creation of experiences discolored 
by association with an unwise timorousness injected by 
parents into the child's allopsychic life. 

I have classified the cases into hysterical and psychas- 

1 Read before the Third Annual Meeting of the American Psychopathological 
Association at Boston, May, 1912. 

407 



408 Psychogenic Disorders in Childhood 

thenic in accordance with the principles laid down, following 
Janet, in a former article/ 

In practice, this classification is useful; but I am not 
sure that these types essentially differ as regards genesis; 
although, to use a mode of expression fashionable nowadays, 
in "make-up" the two types are antipodal. 

Tics and Phobias of Psychasthenic Form in a 
Girl of Eight 

A girl aged eight, an only child, was sent to a Washington 
sanitarium because of numerous grimaces and gestures. 
These led her attendants to believe she suffered from chorea, 
to give her large doses of arsenic, and to isolate her from her 
friends, while overfeeding her. At the end of a month she 
returned to the country, the morbid movements having 
ceased, but suffering from insomnia and unable to go to 
school, in the belief of the parents, because of her "nervous- 
ness," which was especially conspicuous when reading and 
studying were required. When she was nine I was asked to 
see her by her uncle. Dr. Perrie of Lyons Creek, Md., in the 
hope that something further could be done. 

I found a well-nourished, self-contained, sensible child, 
without apparent shyness, over-forwardness, or hyper-ex- 
citability. But she was apt to talk rather fast and stammered 
now and then. I soon discovered that she was fond of play 
and the companionship of which she had been deprived, to 
compensate for which she made believe that the objects and 
person of her play were real. So rigorously was she pro- 
tected that the conceptions of lying and stealing were hardly 
clear to her. She had been very strictly managed and 
scolded and repressed a good deal. She was once whipped 
for persistent dawdling on her way home from school. She 
did not remember other corporal punishments. Her life, 
however, was not felt to be unhappy, for she was very 
obedient, and was not galled by the good manners expected 
of her. However, she wanted to grow up, hated people to call 
her little, and she disliked the spoiling which was a tendency 
of her father before her sickness. Although she did not 
repine at staying from school, she wished to learn to read and 

1 Journal of Abnormal Psychology, 1909, Types Among Psychoneu roses. 



Tom A. Williams, M.B., CM. 409 

write, but as lessons "agitated and kept her awake" she em- 
ployed herself in play. 

The source of the movements she had made was revealed 
after some hesitancy. It seemed that her mother had 
taught her, about the age of five, that people lived by in- 
spiring the air, and what they expired was hurtful. This 
thought led to a distressing compunctiousness about the 
noxiousness of her breath ; "if it was bad it must hurt others." 

Now, her training had been such that to hurt others was 
a great offense. But not to breath was to die. From this 
dilemma she found a way "hurts could be mended." When 
injured did not some one kiss it better.^ Could not she then 
kiss better her own bad breath so that it would not injure 
others? Accordingly she made movements of her lips, 
which represented the healing kiss to ward off the danger of 
the deadly air she expired. 

Later on, her discontent was augmented by scruples 
against the injury she did by walking upon creatures with 
the hard and sharp heels of her shoes. Even the planks of 
the floor were of the animated world, which it was wrong to 
destroy or injure. To assuage the distressing thought of 
this, compensation must be made. She found it in another 
legendarily therapeutic procedure, the healing touch. So 
it became her habit, before walking over an object, to bend 
and touch it with her hand. 

These procedures belong to the class of mental manias 
which Janet, Les Obsessions et le psychasthenie, has called 
manias of expiation. Their motorial character approaches 
them to tics, into which they gradually blend. ^ That they 
had done so to some extent in this case is shown by the 
fact that the kissing nature of the lip movements had not 
been suspected. 

That the movements had not developed entirely into 
mere symbolic vestiges of their original purpose was due to 
their arrest comparatively early. That they would have 
developed into characteristic tics is confirmed by the dis- 
tress the child suffered in overcoming them. She did so after 
being in the sanitarium a few days, and did it deliberately 

1 See author, Tic in Children, Padiatrics, 1910, also case of psychasthenia 
arch of paediatrics, 1910. 



410 Psychogenic Disorders in Childhood 

and by a hard struggle, because she wished to return home, 
and they had promised that she could do so if the move- 
ments ceased. It is possible that the nurse who said this 
had an inkling into the psychological character of the child's 
disorder. After she succeeded the desire to repeat the move- 
ments quickly ceased, although she does not know whether 
she was enlightened regarding her notions about the hurt- 
fulness of expired air and hard heels. 

Proceeding to the genesis of the insomnia and difficulty 
in reading and study, interrogation showed a very simple 
mechanism. Apprehension as to their consequences was 
raised in the child by the attitude of the parents, whose open 
fear lest they should perturb the child reminded me of the 
procedure of the mother of the boy whose hysterical hydro- 
phobia was precipitated by her sitting by his bed reading 
about rabies two weeks after he had been bitten by a sup- 
posedly mad dog. (Miller, Journal Abnormal Psychol- 
ogy, 1910.) So in this case the ostentation of their solic- 
itude provoked in the child that which they feared. 

Treatment. — The explanation of these mechanisms to 
both parent and child was the first task, and it proved very 
simple, for they were intelligent people. The corollary 
that the child was not morbid, except by induction, was then 
set forth. The conclusion was that the child should resume 
study and return to school in the fall in every respect like an 
ordinary child, now that the mother and father were warned 
against the evil consequences of unwise solicitude and the 
induction of hyper-conscientiousness in matters beyond the 
intelligence of a young child. The result has justified ex- 
pectations, the child taking part in the school life with 
enjoyment and remaining free from "nervousness" now, 
two years later. 

Commentary 

Some might explain the case as a "fear-wish" reaction 
of the CEdipus type in relation to father and mother. In- 
deed, to the exponents of the theory upon which it depends 
the patient's history is not without significance, and in the 
absence of a dream analysis they cannot be satisfied in re- 
buttal. The fact, however, rests that a painful complex 



Tom A. Williams, M.B., CM. 411 

originating at least by the fifth year had resulted in psycho- 
genetic symptoms; and this complex depended upon a moral 
concept in which the sexual life seemed to play no part 
whatever, and its therapeusis was effected by rational means, 
taking account only of the explicit mechanism. 

This very plain mechanism of fear of bodily harm from 
without seems to be a much more fundamental feeling, if 
one is to appeal to phylogeny, than is that concerning the 
relations with others termed sexual. 

Even hedonic affects occurring autochthonously in 
childhood, although of the same genus as that which later 
effloresces into sexual emotivity, do not by any means in 
themselves give origin to perturbations of the psyche either 
in childhood or later. I say in themselves, for I believe that 
the perverted affectivity from which arise so many obses- 
sions, phobias, etc., is always the product of induction, if 
not directly and naively from without, at least by logical 
induction from data acquired by observation or didaction 
of the conventions of family and social life. The child's 
avidity to relate himself correctly to these, to behave as a 
grown up, that being of marvelous privileges, is not suffi- 
ciently realized. It makes him seize upon the most trifling 
detail for imitation. One of his objects is to transcend the 
amusement he provokes in trying. The shame he feels at 
the ridicule with which his attempts are so often met causes 
him to keep them to himself in half shame. 

Two Cases for Contrast 

Thus, in a case of psychasthenia of which the analysis 
occupied over a year and would accordingly take too long to 
recount, the obsessions, which were mainly sexual scruples 
fundamentally, had as their basis the moral and religious re- 
pressions of the patient's childhood. It was the horror and 
loathing of everything pertaining to the corporeal which 
caused the child when aged six to look upon a hedonic state 
which used then to occur as a sinful one which prevented 
even speaking of it to the mother, and which was the incentive 
for the repression of indulgences demanded by a most affec- 
tionate nature; for in the family all display of affection was 
discountenanced. It was the lurking fear of that which was 



412 Psychogenic Disorders in Childhood 

awful, because unfaced and vague, but which contained inex- 
plicable potentialities for evil, which later permeated the pa- 
tient's relations with fellow beings to a degree which pro- 
duced utter incapacity for daily life. 

Rapid Curability 

Let me ask you to contrast on the one hand the loss of a 
quarter of a century of fruitful activity by this patient, the 
lack of good sense in whose upbringing was so late compen- 
sated by what we have learned of psychopathology; on the 
other hand, the immediate compensation of an entirely simi- 
lar syndrome in a clergyman's child, aged ten, whom I saw 
last winter. One day she would be well and the next crying, 
feeling miserable, tired, and dizzy, with a dull headache, as a 
result of lying in bed thinking. The preceding summer at 
school she had been irritable, cross, impatient, and quarrel- 
some with her sister. She had formerly been easy to manage 
and full of life and joy. Her mother was most anxious, and 
took pains to avoid startling or fatiguing her; and in the 
belief that it exhausted the child, forbade the impulsive 
squeezing and kissing which the child frequently desired. 
She had noticed that the little girl was less impulsive and 
irritable when having something to do, but she had been 
taken from school, which seemed to aggravate her ner- 
vousness. 

The physical examination was negative with the excep- 
tion of a slight hyperopic astigmia and a variable visual 
acuity, without apparent cause (Dr. F. N. Chisholm, who 
referred her). 

Psychically^ intelligence was normal. She was very 
timid, was hyperconscientious, and much concerned at 
having been reproved for impulsive shouting, for violent 
hugging of her parents, and because of some eau de cologne 
she took. This had really been taken by the little sister, 
who was punished for it. She was sometimes so unhappy 
and miserable that she did not want other children near her; 
and she was most unhappy because she was not allowed to 
show her affection to her father and mother, of whom she 
is very fond, more especially of the latter. Her dreams are 
rare; but she recollected one of a white-bearded man who 



Tom A. Williams, M.B., CM. 413 

dragged her from the bed by her hair and another of a wild 
animal trying to eat her. I could not at the time obtain 
any associations from either of these; and indeed I was more 
concerned in relieving without delay the intensity of the 
repressions which made the child's life a burden. 

A physical factor complicated the case, the child eating 
excessively of meats and oatmeal and making her principal 
meal at night. I believed that this was the initial cause of 
the irritability of temper and the impulsiveness which led 
the over-conscientious parents to repress overmuch. 

Treatment. — Mid-day dinner was prescribed, and a 
supper mainly of carbohydrates and fruit, after which she 
should not go to bed for at least an hour.^ On waking in 
the morning the child must make a practice of getting up 
and going outside instead of ruminating in bed. Parents 
must avoid nagging her about trifles, and her behavior 
must be left to take care of itself at present. Her affections 
must be indulged and reciprocated; she must be given plenty 
to do, and be sent back to school in a few days. This policy 
resulted in complete recovery within two weeks, the child 
being as happy and joyous as she formerly was. 

Diagnosis. — I considered this a prepuberal emotionalism, 
attributable to an incorrect dietary and greatly aggravated by 
parental interference, well meant, but entirely injudicious. 
This last, the psychogenetic factor of the situation, was the 
main pathogen of a state which might have eventually at- 
tained a gravity like that of the case with which it contrasts. 

Thus, the psychasthenia of this little girl was cut short 
long before its root branched into mental manias or before 
there was a hint of obsessions or phobias. It may astonish 
you that I include this case in the psychasthenia of Janet, as 
it is without the stigmata or cardinal symptoms of that dis- 
order, if we except the impulsiveness and the inadequacy, 
which was hardly even conscious. The justification of such 
a diagnosis need not, however, detain us; for it has been set 
forth in explanation of the case of a child, aged only two, 
which I reported to the Psychological Society of Paris in 
1910. (See also Arch, of Pediatrics, 1910.) 

^ See author, Diet in Nervous Disorders, Public Health Jour., June; N. Y. 
Med. Jour., 1912 (Apr. 6). 



414 Psychogenic Disorders in Childhood 

However, in the following case the psychasthenic syn- 
drome was in full efflorescence. 

Mental Manias of Long Standing due to 
Affective Repressions 

A boy aged thirteen was referred by Dr. Guy Latimer of 
Hyattesville, Md., because of extreme timidity and many 
"nervous" tricks, and an inability to concentrate his atten- 
tion. The most conspicuous symptoms were an arithmo- 
mania, a mania for verification including a "delire de 
toucher" and a "manie du sort," one of the forms of which 
was the imperative need of lying on his back on the floor 
at frequent intervals while dressing in the morning. These 
various mannerisms intermitted and replaced one another. 

Analysis revealed that all were in reality expiatory 
penances for a jealousy of his little brother, which had 
already begun at the age of three, when he asked that the 
baby be thrown from the window, and once banged his head 
on the floor while enraged. He himself had always been 
much petted, and craved it. It was the reproval of an 
aunt which first created the shame for his jealousy and led 
him to make penance in these fashions. Latterly he had 
been urged to cease his peculiarities, and can stop any of 
them when on the alert by a hard struggle. His distress at 
doing so, moreover, soon passes away. But his frequent 
absence of mind in day dreams, which he loves, interfered 
with his endeavors. This tendency was favored by his 
not having been allowed to play the games of which he is 
fond with the boys in the neighborhood, which is a rather 
rough one. 

This desire for expiation began when he was between 
three and four years old, by thinking it was "mean" not to 
give his toys away; and so he gave them all to his brother. 
He was told that it was naughty to be jealous, and he felt 
ashamed, but did not cry, but just sank into himself and 
said nothing. He still reproached himself. If his mother 
did not pet him for a week, he thought she did not care for 
him, and so he would be unhappy. 

He does not know the reason why he is jealous of his 
brother, for he loves him, and they do not quarrel much, 



Tom A. Williams, M.B., CM. 415 

even when the other cheats at play. It is in the morning 
and at night that he is most beset by his manias, and he 
feels things would go wrong for day or night if he did not per- 
form them. He declares, "I always seem to want to do 
something I do not want to, because I do not want to." 
He does not know why. And he has no shame of body or 
sex, as he has been fully instructed. He is very religious, 
believing in heaven and hell, that he must be good, and feels 
that he ought to make himself sad because he does not like 
to be sad; but he is so prone to sadness that even as a baby 
music made him cry. So conscientious is he that he under- 
takes every task with too great violence, quickly becomes 
exhausted and then has to fight against the dreamy tend- 
ency which supervenes. 

Treatment. — Having explained together the genesis 
of his desire for penance, we decided to concentrate atten- 
tion upon only one of his manias at a time, in order to break 
one by one the habits he had formed, and he was to take up 
carpentry work in order to combat the tendency to day 
dreaming. His diet was also rectified. 

More and more control was soon obtained. On last 
hearing from him, two years later, he had taken a position, 
and had overcome his disabilities. 

Commentary 

The psychogenetic factor in this case was obviously the 
unwise manner in which an affectionate infant's natural 
jealousy was reproved by over-religious relatives. The 
awfulness of the sin fostered the poor boy's shame thereat, 
and led him to the type of expiation which follows from a 
misapplied asceticism. 

Jealousy, of course, is among the effective appurte- 
nances of the psycho-sexual relation. But even although it 
invariably were so that only a sexual affect were capable of 
provoking this passion, yet we should be far from a postu- 
late that such a psychasthenia as this boy's was generated 
by this psycho-sexual perturbation itself, for the case history 
clearly shows that the expiatory manias of the boy were not 
due to the jealousy itself, but to his efforts to compensate for a 
feeling he could not help, and which he blamed himself for 



416 Psychogenic Disorders in Childhood 

feeling. It was the struggles of an ill-conceived asceticism 
which initiated the psychasthenia; that is to say, the mechan- 
ism was fundamentally conceptual and not affective. Had the 
vague and ill-founded ratiocinations of the child been clarified 
by proper information and advice, there would have been 
no manias; for in dealing with his jealousy, rationalism 
would have superseded what was intrinsically superstition. 

The foregoing argument points to the genetic similarity 
to hysteria of psychasthenia. It seems to show that by the 
autochthonous elaboration of an implanted idea, a sugges- 
tion, the consequences of which should be called hysterical, 
(see Nature of Hysteria, International Clinics, 1908. Affec- 
tivity in Traumatic Neurosis, Journal of Abnormal Psy- 
chology, 1910, and various other writings), there can develop 
the typical psychasthenic syndrome of Janet. It would take 
us too far to discuss the implications of this statement, and 
to decide whether inherent psychological make-up, physiologi- 
cal factors, or the nature of the psychic environment is the 
agent which determines differences of reactions so great as 
those of the eminently suggestible hysteric and the psychas- 
thenic, whose resistance to suggestions Janet found so great 
as to entirely preclude hypnosis. Besides, my own opinion 
thereon is unformed, and must await further material for 
study or contributions by other observers. 

The case which follows is frankly hysterical and needs 
no comment. 

Hysterical Phobia in a Child 

A boy of eight was seen with Dr. A. L. Tynes, 
at Staunton, Va., in the autumn of 1911. The preced- 
ing May he had developed what his parents called hal- 
lucinations, which occurred when he was alone only, 
for he would go errands and play about if he knew he 
was in sight of any one at all. There were no night 
terrors, although he feared going to bed alone, and his 
mother or father always accompanied him upstairs. When- 
ever he was alone a spell would occur. The hallucinations 
were accompanied by a loud cry and a twisting backwards 
of the neck and contortion of the body. He was very 
rarely still, wriggling about nearly all the time in an ex- 
citable fashion. His father and maternal uncle are de- 



Tom A, Williams, M.B., CM. 417 

clared to have had similar attacks in childhood. But it 
could not be ascertained that the parents had not spoken 
of some of these before the boy. The mother was over 
anxious, hysterical, and very uneasy when the boy was out 
of her sight, of which the boy was well aware. 

Examination revealed no physical signs of disease of 
the nervous or any other system. In anamnesis, I found 
him a sensible little fellow; and I ascertained that it was a 
snake which he usually saw, although sometimes a wild 
beast would be seen. His shout was really the name of the 
animal he saw. He could not describe the snake except 
to say its head was like an eel. He remembered well the 
first such occasion of fright; and the creature then was not a 
snake but a rooster. He declared that he was never actually 
afraid of any animals. Indeed, on one occasion, wearing 
a red sweater, he chased a bull away with stones. On 
another occasion, he went into the cellar to look for the 
bogey-man. He said that his only fear was that of being 
whipped by his father when he was naughty, and that of 
this he was "not very frightened." 

I could not, in the short time at my disposal, penetrate 
the psycho-genesis completely. My questions, however, 
soon showed that the hallucinations were not true ones; 
for when I asked the boy if when he looked round there 
was really an animal jumping on his shoulders, he had to 
reply "no"; and that he never actually saw, heard, or felt 
what he feared. He then spontaneously declared, "I reckon 
my imagination gets away with me." I then asked him, 
*'Why do you not look round each time you fear the animal 
behind you.^" He said, "It does not give me time to think 
of it; it comes so quickly sometimes, and I shout and run 
before I can recover myself." When asked, however, he 
said he was not easily startled as a rule. 

Diagnosis and Prognosis. — Familiarity with the me- 
chanism of terrors of children enables one to interpret this 
boy's case as a phobia against being alone, produced by 
the foolish anxiety of his mother. This aifective state was 
an induced one, therefore, produced by the idea of some 
*' dreadful consequences" which might occur to a little boy 
when not protected by his elders. But the morbid reaction 



418 Psychogenic Disorders in Childhood 

had become a habit; so that even though the initial cause 
were suppressed, training would be required to overcome the 
facile inductibility of the terrors. Inhibition of his undue 
impulsivity should also be undertaken. 

Treatment, — Accordingly the following procedures were 
outlined and the reason for them clearly explained to the 
boy and his father. Firstly, he must gradually accustom 
himself to go out alone, first for half a block, then for a whole 
block, and finally round the corner. While doing this, he 
could hold himself in hand, his attention fully awake to the 
need of manly behavior and the importance of recovering 
from his timidity. Secondly, he must learn to go to sleep 
without any one else in the room, remembering what a 
nuisance is a boy who cannot forego keeping one of his 
parents constantly at home in the evening. Thirdly, he 
was shown exercises in slow movement and mobilization 
by which he could suppress the wriggling tendencies of his 
limbs and body. His mother should be dealt with ration- 
ally, too. As a result no further attacks have occurred. 

Wishing to obtain more precision as to the psychic 
mechanism, I wrote to the boy asking him to tell me whether 
he seemed to be in a dreamlike or in an absent condition 
when the fears assailed him. I also, of course, wished to 
stimulate the practice of the re-educative procedures I had 
prescribed. The following replies were made, and I have 
recently head from Dr. Tynes that the boy remains well. 

"My dear Sir: — I beg to thank you for your letter of 
yesterday to John, Jr., and at the same time report favorable 
progress in his case. He is now going all about the house and 
yard alone, and has made a couple of trips to the store where 
I am employed (about seven minutes' walk) alone. He is 
certainly very much better than he has been since these 
spells of fright came upon him. He is getting on well with 
the exercises that you outlined for him, though he has not 
yet been able to go to sleep alone. However, he goes up 
to the room alone, turns on the light, undresses, and gets 
in bed, and holds himself together for about ten minutes, 
but does not seem able to compose himself sufficiently to 
get to sleep. I am working him up to this as fast as I can, 



Tom A. Williams, M.B., CM. 419 

and while I might force him to it at once, I would have to 
use harsh measures to accomplish it. I am unable to 
clearly get the idea from him whether after these attacks 
of fright the animals seem like a dream or an idea. I be- 
lieve, however, when he tries to analyze the feeling, that 
he feels that it was an idea that flashed through his mind 
at once that these animals were near him, and he knows 
it was only in his imagination. I am glad to say that he is 
making a strong effort to get a 'grip' on himself, and I 
believe that he will succeed. I will let you hear from him 
from time to time, and if at any time I can answer any 
questions I will be only too glad to do so as clearly as I can."' 

"Dear Doctor: — I have your letter. I do not see any 
animals since I saw you. I never did hear or fear them, 
but used to see them. It is not like a dream. I hope 
I can soon write you I am well. 

"Your Little Friend." 



THE MENTAL MANIFESTATIONS OF EPILEPSY^ 

BY N. S. YAWGER, M.D., PHILADELPHIA 

Examining Physician to the Pennsylvania Epileptic Hospital 
and Colony Farm 

OF all known diseases, none have such mysterious 
and weird manifestations as epilepsy. In some 
unexplained way the process of sleep may be 
the only assignable cause of an epileptic attack, 
and this constitutes what is spoken of clinically as the noc- 
turnal form of this disease: if one subject to night seizures 
sleeps during the day, the attacks may occur then, and it is 
often during the deepest sleep that a fit is provoked; when 
there is but an occasional nocturnal convulsion, the malady 
may exist throughout life and remain unrecognized; and, 
when the seizures are mild and infrequent, their occurrence 
in some persons has been effectually concealed for a long 
time. One afflicted with this disease may, without a mo- 
ment's warning, be felled to the ground in an unconscious 
and spasmodic state; sometimes a seizure does not cause 
more than a fleeting and an almost imperceptible change in 
the psychic equilibrium; or, again, the manifestation may 
be so grave as to instantly drive its victim to the utmost 
violence, and subside, leaving him entirely oblivious of his 
actions and deeds. 

Of recent years the mental manifestations of epilepsy 
have received more and more serious consideration. Pre- 
viously, the motor disturbance was regarded as the cardinal 
element in the disease, but most authorities now believe 
that in order to establish the diagnosis of epilepsy there 
must at least be some attacks in which there is sudden, 
temporary impairment or loss of consciousness. 

Some writers have endeavored to establish a relation- 
ship between genius and epilepsy, based upon the statement 

1 Read before the Chester County Medical Society at Embreeville, Pa., 
July 9, 1912. 

From the Department of Neurology in the University of Pennsylvania. 

420 



N. S. Yawger, M.D. 421 

that a number of great men have had, or were alleged to 
have had, this disease. Among those cited are Mohammed, 
Csesar, St. Paul, Mozart, Richelieu, Swift, Swedenborg, 
and Napoleon; we have no good reason for believing that 
most of these men had epilepsy, and there probably is no 
such relationship; as all segregations of epileptics will show, 
there are enormous numbers who at no time during their 
existence have evinced more than commonplace mentality; 
indeed, intellectual impairment is to be expected in these 
individuals, and the instances where complete mentality 
has been preserved are most exceptional. Undoubtedly, 
it is true that disease amounting to an affliction has at times 
kept individuals away from the less serious things in life, 
and for this reason they have abandoned themselves to 
hard work and their endeavors have led to fame; but great 
men afflicted with a disease of an epileptic nature, undoubt- 
edly, have not become famous because of this association. 

Since epileptic seizures are prone to have a disin- 
tegrating effect upon the mentality of the individual, these 
insults, when often repeated, almost invariably leave a 
permanent impression upon the mental state of its victim; 
this, with the terrible nature of his malady and its probable 
incurability, together with his being set apart from normal 
persons and conditions, have been the causes given for the 
development of what is termed the epileptic character and 
temperament. "It consists," Peterson^ states, *'of a 
mixture of melancholy, hypochondriasis, emotional irri- 
tability, moroseness, distrust, misanthropy, mental apathy, 
and dullness, often combined with religious tendencies and 
modified by pathological psychic conditions incident to the 
ravages of the disease." However, it may be that the 
development of this state, so peculiar to an epileptic, is due 
in part to the mismanagement of these unfortunate persons 
by their families, and not to such a marked degree by the 
disease itself; this seems more especially true of that class of 
cases where there is not sufficient means to provide suitable 
attendants for these children; and this point is rather strik- 
ingly brought out in "The Autobiography of an Epileptic. "^ 
This individual, when a child, was unusually bright; he 
had his first attack in school, and he was not allowed to 



422 Ihe Mental Manifestations of Epilepsy 

go there longer; later, while out with one of his family, he 
had an attack on the street, and after this he was kept at 
home most of the time; he was accused of violence towards 
the younger children; of this he knew nothing, and he be- 
lieved such stories were told against him for spite. There- 
fore, having no knowledge of these misdoings, he naturally 
thought that instead of lying, he was lied about. This 
epileptic writes: "The injustice I suffered, or thought that 
I suffered, made me morose, jealous, suspicious, brooding, 
and I could hardly be civil to those belonging to my home. 
I despised them all and felt that I should like to do the 
things they accused me of doing." At times it may be as 
one writer says, "The epileptic is forced to develop to some 
extent on the lines of the untutored savage. This fact 
explains why the full-grown epileptic has often many of the 
qualities of the savage." 

Epileptic seizures do not always appear unannounced, 
as an aura or warning frequently precedes the attack; this 
may occur alone or in association with a warning in another 
part of the body; sometimes such manifestations consist of 
the subjunctive sensations of smell and taste; or the individ- 
ual may feel intensely apprehensive, and, as the instinct of 
fright is often the subjunctive feeling or emotion of fear, a 
patient in this mental state may be impelled from home. 
One epileptic whom I recall seeing suddenly bounded for- 
ward directly towards a large tree, and had he not been 
caught by an attendant and brought to the ground he would 
probably have been injured; his fit followed in a few seconds. 
If a psychic aura were the only manifestation of an incom- 
plete attack, the absence of motor symptoms would render 
the disturbance indistinguishable from psychic epilepsy. 
Hughlings Jackson^ wrote of a "dreamy state" in asso- 
ciation with what he termed an intellectual aura, and this 
mental condition a patient of his described by stating that 
^*he felt as if he were saying, doing, and looking at things 
which he had experienced before." This, it seems, amounts 
to a psychasthenic state occurring in an epileptic, and for 
this condition Janet'^ has coined the term "psycholepsy." 

As previously stated, some disturbance of conscious- 
ness is of paramount importance, and it is now believed by 



N. S. Yazvger, M.D. 423 

many that to establish the existence of epilepsy there must 
be sudden, temporary impairment or loss of consciousness; 
it is true at times phenomena are observed in these patients 
in which there is no such disturbance, but to establish the 
diagnosis there should be at least some attacks in which 
the cardinal symptom, a sudden temporary disturbance of 
consciousness, is actually present. Such disturbance may 
be slight and momentary, or it may amount to absolute 
unconsciousness and exist for several minutes; again, it 
may be of several months' duration; sometimes, during such 
a period, the patient acts most strangely and usually without 
subsequent knowledge of his behavior. With this disturb- 
ance of consciousness as the requisite, one cannot but feel 
that a diagnosis of epilepsy may not be made if the attacks 
occur only during sleep. 

Just how such disturbances of consciousness are brought 
about it is impossible to positively state, but the best ex- 
planation appears to be that of discontinuity of conduction 
at the junctions of the neurons. 

In a complete epileptic seizure, absolute unconscious- 
ness usually follows promptly after the appearance of the 
aura if this is present; it continues through the tonic and 
clonic stages and into the period of stertor. This uncon- 
sciousness usually lasts from a few seconds to about five 
minutes, and is followed by a period of perhaps half an hour, 
during which time the patient lies profoundly comatose; 
natural sleep then gradually supervenes, and from this the 
individual awakens somewhat confused; this confusion may 
be brief or it may persist for hours. If seen only in the stage 
of coma, the possibility of the condition being due to alco- 
holic or other drug intoxication, apoplexy, diabetes, or 
hysteria might have to be considered. 

In status epilepticus fit follows fit, at times even to 
several hundred, and without the return of consciousness; 
this is the gravest of epileptic paroxysms, and it leads to 
about ten per cent of the deaths occurring among epileptics. 
The status may be precipitated by some such cause as a 
blow, it may be induced by an acute infectious process, 
it is at times the termination of long standing cases of 
epilepsy, and frequently it develops without assignable 






424 The Mental Manifestations of Epilepsy 

cause. So-called serial epilepsy may be regarded as a 
subacute status. 

Complete temporary loss of consciousness was observed 
in a case which I examined recently; while making a neu- 
rologic study of this patient, I observed that she drew rather 
a long inspiration, and upon glancing at her face saw that 
there was just a slight suggestion of tremor about her eye- 
lids; her eyeballs turned upward, and she wavered slightly, 
but she did not fall; in about ten seconds she looked at me 
in a dazed sort of a way and then regained complete con- 
sciousness. Upon two occasions I chanced to have a 
sphigmomanometer attached, and during the seizures there 
was no appreciable fall in blood pressure. This patient 
had no previous warning of these attacks, nor had she sub- 
sequent knowledge of them. Seizures of this kind are classed 
as psychic epilepsy; they are not uncommon, and at times 
pass for cardiac syncope. Such manifestations lend addi- 
tional gloom to the prognosis. Some persons are aware of 
having had such attacks, and it has been my experience 
while examining patients to have them tell me that they 
have just had a " spell," and these may be so mild and of such 
short duration as to be unobserved except by the patient. 
Sometimes major epilepsy has begun in this way, and it 
may then be several years before the more severe symptoms 
appear. 

It is important and at times difficult to distinguish 
between psychic epilepsy and cardiac syncope; in the latter 
condition the disturbance of consciousness is less sudden 
and less complete, except, of course, when the attack is 
fatal; if the individual falls, there is scarcely ever an injury 
sustained; mental confusion does not follow; the reflexes 
are less apt to be abolished; pallor of the face is observed, 
and in psychic epilepsy this probably is not the first sign; 
weakening of the pulse is present in syncope, but it is 
scarcely ever an accompaniment of epilepsy; the patient 
may attempt to rise and again lose consciousness; if a 
sphigmomanometer observation is possible, a fall of blood 
pressure is shown. 

Strange to say, epileptic attacks may be for a time 
inhibited by anything that holds the attention of these 



N. S. Yazuger, M.D. 425 

patients. It has often been observed at the Oakbourne 
Colony, that during an entertainment of an hour's duration, 
the children, perhaps, are all free from seizures, whereas, 
during the same period at another time, five or six fits would 
probably occur. It is also well known that an acute illness, 
either infectious or otherwise, usually has an inhibiting 
influence upon epileptic seizures. The attacks may even 
cease for months, but they almost invariably return. The 
cause of this strange influence is not known. 

The mental manifestations of epilepsy have been com- 
prehensively classified by Turner ^ who considers the 
subject under the following headings: 1. Epileptic tem- 
perament; this has already been mentioned. 2. Par- 
oxysmal psychoses, which either precede or succeed the 
convulsive phenomena. 3. Paroxysmal psychoses, which 
replace single fits or a series of fits (psychic equivalents). 
4. Permanent inter-paroxysmal mental condition. Some 
of these headings are extensively elaborated by this writer. 

About ten per cent of all epileptics become insane, and 
these constitute some ten per cent of the population of 
asylums. Since the disease in itself is seldom fatal, epilep- 
tics usually living beyond middle life, these patients "accum- 
ulate" and, therefore, they do not represent ten per cent 
of the admissions into asylums. However, these figures 
are affected by the increasing number of patients maintained 
in hospitals and in colonies devoted to their exclusive care. 
In all places where large numbers of epileptics are segre- 
gated, a few are found to be the victims of moral depravity. 

The paroxysmal psychoses may precede, may succeed, 
or may replace the convulsive phenomena; the last are 
known as psychic equivalents. 

Epileptic insanities are of various types; they may be 
broadly included under the term manic-depressive mani- 
festations, or they may be classed separately as mental 
confusion, hallucinosis, mania, melancholia, and acute 
dementia; however there is this distinction to be made from 
the classic psychoses — acute epileptic insanity is more 
precipitate, more intense, of shorter duration, and termi- 
nates more abruptly than insanity of other origin. 

The epileptics in insane hospitals are invariably classed 



426 The Mental Manifestations of Epilepsy 

as the most dangerous and the most troublesome patients 
that require detention. 

Preparoxysmal manifestations sometimes present them- 
selves, and they are important as their recognition enables 
those in attendance to be watchful of these individuals. 

Such symptoms are known as prodromes, and they 
consist for the most part of irritability, excitability, depres- 
sion, unusual slowness of cerebration, insomnia, a feeling 
of unrealty, and occasionally hallucinations; these mani- 
festations may occur hours or even days before the attack; 
while in this state the patient is sometimes impelled from 
home; the prodromal symptoms mentioned are not to be 
confounded with the psychic aura previously described; 
the latter is brief, and it invariably occurs immediately 
before an attack, with this possible exception, that, rarely, 
the attack may fail to appear. 

An epileptic psychosis most commonly succeeds the 
convulsion, and it usually lasts but a few hours, although in 
rare instances it may extend over a period of weeks. The 
milder manifestations are for the most part delirium, stupor, 
or confusion, but the rapidity of the actions and thoughts 
may conform to the more serious condition of mania, and 
acts of violence are at times committed; there is usually no 
subsequent recollection of the conduct during such a period, 
but at times the individual may have a hazy idea of what 
has happened. A patient whom I have seen on a number of 
occasions, forty years old, had convulsions in infancy, has 
had minor epilepsy for the last five years, and major attacks, 
occurring about once a month, for the last three years. 
During the interparoxysmal period his conduct is ex- 
emplary, even better than that of the other forty-eight 
patients in the same ward; but for about ten minutes follow- 
ing a fit he often becomes dangerous, and he may then 
attack any one who comes near him; once he succeeded in 
getting a knife and concealing it under his pillow; because 
of these brief dangerous periods he is of necessity detained 
in an insane hospital; all subsequent knowledge of his ac- 
tions during the periods of excitement is denied by this 
patient. The sudden deprivation of large doses of bromide 
may at once cause an acute psychosis to develop. 



N. S. Yazvger, M.D. 427 

Automatic acts are very frequently to be observed after 
epileptic seizures; perhaps the most common of these is an 
attempt to undress, and Ernest Jones^ is probably in 
error when in this connection he says, "The tendency to 
undress partly that is so frequently seen just after an attack 
of major or minor epilepsy is also of exhibitionistic origin." 
In refutation of this, I know of patients who automatically 
assume the attitude of prayer almost as often as they attempt 
to undress; furthermore, I have questioned female attendants 
of large experience among male epileptics, and have been 
informed that during automatic acts they have not observed 
anything suggestive of indecency; probably, as Gowers'^ 
suggests, this tendency to undress is from some vague sense 
of indisposition and the propriety of going to bed. I recall 
one patient who would at times undress, place on her night 
garment, and actually get in bed before returning to com- 
plete consciousness. 

The more extensive phenomenon of automatism is oc- 
casionally observed, and this may become a question of the 
gravest medico-legal import; in this mental state the patient 
sometimes behaves most strangely; occasionally he may 
expose his person, or perhaps he may wander from home and 
be gone for weeks, or even months; overt acts are at times 
committed, and upon the return of complete consciousness 
there may be no knowledge of the behavior during such a 
period. If this state were to appear independently of any 
motor or sensory disturbance, it would constitute the psychic 
•equivalent of epilepsy. As Spratling^ says, "Psychic 
epileptics may commit all manner of crime; theft, arson, 
rape, assaults, homicides. They are not infrequently pyro- 
maniacs entirely without reason or impelled by the flimsiest 
motives." It should be borne in mind that occasionally 
automatism is met with also in alcoholism, hysteria, and in 
-degenerate persons. 

Confirmed epileptics are much inclined to religious 
observances; this, however, does not appear to arise from 
any deep-seated religious feeling, but rather as an automatic 
process resulting from previous religious training; some- 
times marked religious enthusiasm precedes a maniacal out- 
break. Spontaneous attacks of crying or laughing may appear. 



428 The Mental Manifestations of Epilepsy 

Dream states, or a stuporous condition, may develop 
and sometimes there is a maniacal episode; also, narcolepsy 
has been observed to replace attacks, and from this the 
patient cannot be awakened. 

Somnambulism, which is really the acting of a dream, 
occasionally occurs among epileptics. 

Generally speaking, after the disease has persisted for 
some time, the memory becomes impaired and this amnesia 
follows the usual rule where memory fails gradually, in 
being most defective for recent events. Since the failure 
of memory cannot be reproduced, it is an amnesia of con- 
servation, and not, as Ernest Jones^ has said, an amnesia 
of reproduction; in the latter instance the failure of memory 
might be recalled.by hypnosis, and the state should then be 
regarded as one of hysteria. 

Mental failure need not be the necessary result of 
epilepsy, as in rare instances the affection has been observed, 
not to be incompatible, with retention of all the normal 
mental faculties. Usually, however, there is an ultimate 
dementia, and it differs in nowise from that of other in- 
sanities except by the presence of fits. Epileptics do not 
often attain to an extreme age, but they may live sufficiently 
long for the dementia to become absolute. 

References 

1. Church-Peterson. Nervous and Mental Diseases. W. B. Saunders 
Company; Philadelphia, 1908; p. 812. 

2. Alexander. A Clinical Lecture on the Autobiography of an Epileptic. 
The Medical Press and Circular, April 12, 1911; Vol. XCL., p. 382. 

3. Case of Epilepsy with Tasting Movements and "Dreamy State," Brain, 
1898; Vol. XXI, p. 580. Epileptic Attacks with a Warning of a Crude Sensation 
of Smell and with an Intellectual Aura (Dreamy State); Brain, 1899; Vol. XXII, 
p. 534. 

4. Les Obsessions et la Psychasthenic; Felix Alcan, Editeur. Ancienne 
Librairie Germer Bailliere et Cie; Paris, 1903; Vol. I, p. 502. 

5. Epilepsy. Macmillan & Co., London, 1907; p. 118. 

6. The Mental Characteristics of Chronic Epilepsy. Maryland Medical 
Journal; July, 1910; Vol. LIII, No. 7; p. 223. 

7. Allbut and Rolleston. Svstem of Medicine. Macmillan & Co.; London, 
1910; Vol. VIII, p. 503. 

8. Spratling. Epilepsy and Its Treatment. W. B. Saunders Co., Phila- 
delphia, 1904; p. 445. 



ABSTRACTS 

LE CAS DE RENATA. CONTRIBUTION A l'eTUDE DE l'hYSTERIE. 

L. Schnyder. archives de psychologie, Vol. xll, No. 47, pp. 
201-262. 

In this lengthy paper, the author records in detail the history 
and analysis of an Intelligent hysterical subject In the hope of 
throwing some light upon the mechanism of the psychoneuroses In 
general and of hysteria In particular. An hereditary tendency 
was present in this case, in that the brother of the subject suffered 
from a psychasthenic disorder, which rapidly Improved under 
psychotherapy combined with rest and overfeeding. The sister, 
called Renata, who forms the subject of this study, was a young 
woman, twenty-five years of age, of a decidedly religious type. 
The analysis was at first strongly antagonized by the subject, and 
this antagonism, in the light of later developments, was shown to 
be a typical defense-reaction. Because of the subject's poor state 
of nutrition, resulting from her anorexia and vomiting, a course of 
rest and overfeeding was at first prescribed. While this amelio- 
rated the physical condition, the mental state was unaffected. The 
data showed the following clinical history. Four years before 
coming under observation she began to suffer with violent head- 
ache and vomiting. As a consequence she lost In weight and 
finally alternating periods of depression and excitement, difficulty 
in thinking and insomnia were added to the disease picture. One 
day she suddenly developed what appeared to be a semi-hypnotic 
state, cried out that she was unable to move and went into an 
hysterical crisis, consisting of lethargy, inability and refusal to 
open the eyelids, repeating, "To open the eyes is to live and I am 
afraid to live." In these crises she was also negativistic and dis- 
oriented. For these episodes she was completely amnesic. In 
spite of the complaint of extreme lassitude, she was able to take 
long walks without the slightest sign of fatigue. Sleep was poor, 
and during the night she developed somnambulistic attacks, in 
which she would write for hours, without any memory for the con- 
dition on resuming her normal state. Psychasthenic scruples 
concerning purity were also present to a marked degree. 

Since it appeared that an unconscious mechanism was at work 
in the production of the various psychoneurotic symptoms, the 
fragmentary words and phrases written in the somnambulistic 
state were successfully utilized In an attempt to tap this uncon- 
scious mental state and thus arrive at the origin of the disturbing 

429 



430 The Journal of Abnormal Psychology 

complex. Most of these phrases were written in English. By 
means of these phrases and free association procedures it was 
possible to fully explain the meaning of the fragmentary English 
terms. Thus the following data concerning the origin of the psycho- 
neurosis were secured. 

In childhood she became obsessed by ideas concerning purity, 
because at home she heard so much concerning the conduct of life. 
Through her rigid home training she was kept in ignorance of 
sexual matters, until finally at puberty sexual questionings of a 
rather obscene nature began to arise. This caused nervous dis- 
turbances, because she had been taught that vulgar thoughts and 
wishes were synonymous with vulgar and sexual acts. Consequently 
at the age of about eighteen, nervous crises began to develop, 
and certain English words such as "voluptuous" and "sensuality" 
began to obsess her. In an efi^ort to repress these thoughts, which 
became more intense at night, a marked insomnia arose. Thus 
sleep began to be disturbed by nightmares and dreams of a sexual 
character, and a repulsion for her bed could be shown to possess a 
distinct sexual significance. 

In her somnambulistic state the English words which she 
dictated, such as "own thinking, " "talking," "eating," "feeling," 
could be shown to possess a sexual significance. For instance, 
"thinking" signified a lack of chastity^ and therefore she must not 
think; "eating" meant a flattering of taste, and therefore she must 
not eat, etc. The meaning of these and other English words were 
twisted and transformed into a sexual significance with a dialectic 
worthy of a medieval philosopher. For example, she explained 
her refusal to eat on the basis that this would mean a gain in flesh, 
and thus her form would become outlined, and this meant sen- 
suality. Physical contact likewise meant sensuality, and so she 
refused to dance or to kiss the members of her family. 

Certain specific memories were also brought out through this 
free association procedure by utilizing the fragmentary phrases 
dictated in the somnambulistic state. A typical example is the 
following: The word "non-kissing" revealed the following child- 
hood complexes. When very young, the question of marriage had 
for her an extraordinary attraction. She had endless reveries 
concerning sexual matters, the question of birth, the religious signifi- 
cation of marriage, etc. At the time of her communion there 
developed a mental conflict concerning the question as to whether 
she should marry or lead a chaste, religious life and, as a result, 
there developed depression and anxiety. At eighteen the scruples 
became more intense, as a consequence she attempted to shut out 
the external world by keeping the eyes closed and passing her time 



1 



Abstracts 43 1 

In revery and sleep, because she hated to keep in touch with reality. 
Thus her somnambulism developed as a reaction of defense, for in 
the somnambulistic state, with its amnesia, she found a refuge from 
the rapidly developing psychasthenic doubts, scruples, and obses- 
sions. Consciousness became narrowed to the performance of only 
the subject's actions, and thus she would pass hours without mov- 
ing or days without eating. A kind of a double personality there- 
fore arose; on the one side life with its painful realities, on the other, 
reveries and somnambulism with its freedom from doubts and re- 
sponsibilities. She was then able at will to shut out the realities 
of life, and the shut-in personality which developed finally be- 
came automatic. This mental attitude was well expressed by the 
patient in the words, "If you only knew what compensation I find 
in my disease." 

Thus the vomiting and anorexia, had purely a psychic origin. 
She retained food only if she were fed while in the somnambulistic 
state, because in this state she was free from the peculiar somatic 
sensations which she associated with eating. In addition, it could 
be shown that problems concerning sexuality always constituted 
the source of her phobias. For example her aversion for pointed 
objects had a phallic significance. A violent hemlcrania, on analysis, 
was also shown to be a defense reaction, because when she had the 
pain, she could not at the time think of the responsibilities of life. 
The phenomena of conversion In the sense of Freud and of Ueber- 
tragung were quite marked. The dreams were also sexual symbols, 
such as wishes for marriage, embarrassment, dreams of nakedness, 
etc. Recovery finally took place, principally through a utilization 
of free expression of her repressed thoughts and mental conflicts, 
the key to which was furnished by her dreams and by the auto- 
matic writing done in the somnambulistic state. 

The author's discussion of the condition and his attitude 
towards the Freudian psychology is interesting. If not convincing. 
Here is the case of an intelligent young woman who developed a 
psychoneurotic disturbance with severe anorexia, due, as already 
shown, to unconscious mechanisms, pre-eminently of a sexual 
nature. A difficulty of judgment arose, caused by her childhood 
errors concerning sexual matters and thus she became Incapable of 
struggling with the realities of life. Therefore she attempted to 
shut out these realities by living in a wish world of unreality, of 
dreams, reveries and somnambulism, which formed a real haven of 
refuge for the struggles of her psychoneurotic symptoms, a 
mechanism which is found In so many hysterics. Thus hysteria so 
frequently shows an Infantile mental reaction, because the symp- 
toms are defense responses to the difficulties and realities of adult 



432 The Journal of Abnormal Psychology 

life. The repression of the childhood sexual fantasies proved dis- 
astrous and upset the mental equilibrium. 

Sexuality, however, according to the author, is not always the 
determining agent and psychoanalysis is frequently only a means 
of diagnosis and examination. The sexual conflicts in childhood 
may not be the cause of the hysteria, but merely serve to form an 
hysterical character. In this case, as in many others, there was 
not a simple psychic trauma, but rather a continual emotional situ- 
ation, made up of a defective attitude towards life. By means of 
this Insufficiency of childhood mentality, the Individual becomes 
unable to completely adapt himself to these realities of life. While 
certain unconscious complexes may furnish the key to individual 
symptoms, they do not explain the entire psychoneurosls. Psycho- 
analysis removes symptoms, only when at the same time we ex- 
plain the symptoms to the patient and reassure him. This result 
is partly forced and partly due to the added suggestive therapy in- 
volved in the treatment. Psychoanalysis is not Indispensable 
for the treatment of the psychoneuroses. The study of the mental- 
ity of the subject, of his antecedents, of determing causes rather 
than the unravelling of unconscious complexes, is more simple and 
valuable. 

The author objects to symbolic Interpretations, and yet In his 
discussion of the dreams, the reveries and the fragmentary words 
written in the somnambulistic state, he Is continually Interpreting 
them In a sense that seems to signify symbolisms. Psycho- 
analysis for him is not a therapeutic procedure, but merely a means 
of tapping unconscious complexes, of utility for the solution of 
certain psychopathological difficulties. He disclaims his faith in 
the therapeutic value of psychoanalysis, yet has used it in conjunc- 
tion with other procedures in the treatment and study of his case. 

I. H. CORIAT. 



LES DYSPSYCHiES. Maurice Dide. l'encephale, Vol. vii, 
1912, No. 3, p. 222. 

The designation dyspsychia Is suggested for all mental states 
presenting a disharmony of the intellectual faculties irrespective 
of etiology or pathogenesis. 

As outlined by the author this term would be applicable to the 
following general states: (a) Disorders of judgment In which the 
subject is unable to assign to the various elements within the 
conscious field their relative place. Such undue stress upon cer- 
tain of the psychic factors may lead to delirium of interpretation, 



Abstracts 433 

and may be the basis of many a so-called sensorial Illusion. 

(b) Disturbances of voluntary attention (usually a diminution, 
while automatic attention may be either Increased or decreased). 

(c) Anomalies In the associative course of Ideas; these depend 
largely upon disordered voluntary attention. 

Hallucinations, when present are purely episodic In character. 
Kynesthetic changes form the substratum for the objective mani- 
festations of the various dyspsychias. 

The dyspsychias are usually light and transitory. They 
present no mental confusion even In their severest form. In cases 
of chronic evolution exacerbations and remissions are the rule, 
but the Intellect remains unimpaired. Disorders of memory, when 
present, are due to insufficient reproduction rather than to im- 
proper registration or conservation. 

Dyspsychias may be remittent, intermittent, or mixed. The 
delirious interpretations, the impulsions, and obsessions, amnesia, 
melancholia and hysteria form the essential dyspsychias. Hysteria 
is essentially a failure of psychic synthesis: cerebral activity is 
dissociated so that certain of its elements appear beyond recall 
at a given moment, only to appear to surface at some other, when 
the main consciousness Is obscured in turn. 

J. S. Van Teslaar. 



LES DELIRES HALLUCINATOIRES CHRONIQUES. Rene MdSSelon. 

l'encephale, Vol. vil, 1912. No. 2, pp. 135-150; No. 3, 254-262. 

The author finds that the new Kraepelinian theories con- 
cerning hallucinatory delirium are untenable in the light of clinical 
experience. He maintains that the analogies between the delirium 
of interpretation and the systematic hallucinatory delirium, the 
occurrence of Intermediary states which link these two condition 
to paranoid dementia, furthermore, the fact that these various 
psychopathic states develop upon a common background justifies 
the grouping together of all these different states Into one great 
class, — paranoia. The various constitutional psychoses thus 
brought together are to be distinguished from the acquired psy- 
choses of which dementia praecox is the most significant type. 

While certain close analogies bring together all the psychoses 
which develop upon a paranoiac temperament a certain number 
of equally Important particularities divide each from the rest and 
give it a place of its own within the group of paranoiac disorders. 
The following varieties are distinguished: 



434 The Journal of Abnormal Psychology 

(a) Persecution or revenge delirium. 

(b) Delirium of Interpretation. 

(c) Hallucinatory systematic delirium. 

(d) Paranoid dementia. 

These various clinical conditions vary In their degree of 
differentiation from the paranoid temperament or constitution 
which Is common to them alike. The least differentiated and 
therefore most directly allied to the paranoiac temperament is the 
persecution or revenge delirium. The others represent acquired 
states evolved to different degrees of complexity and clinically 
stand farther away from the constitutional basis they share In 
common. The various morbid conditions are to be looked upon 
as different reactions of the paranoiac temperament, the difference 
being conditioned by different groups of exciting factors. 

J. S. Van Teslaar. 



ZUR LEHRE VON DEN PSYCHOPATHISCHEN KONSTITUTIONEN : 
NOSOLOGISCHE STELLUNG UND EINTEILUNG DER PSYCHOPATHISCHEN 

KONSTITUTIONEN. Th. Ziehen, charite annalen, Vol. xxxvi, 
1912, p. 130-148. 

As is indicated In the subtitle to this portion of his paper, 
Ziehen discusses here the nosology and classification of the psy- 
chopathic constitutions. The symptomatic standpoint Is the one 
preconlzed for purposes of classification although Ziehen admits 
that certain groups of causative factors may give rise to definite 
psychopathic states. 

Following are the landmarks along which the various psycho- 
pathic constitutions must be outlined: 

1. The extent to which all or nearly all psychic functions 
are Involved in the psychopathic process. 

2. The relatively sHght degree of the more permanent 
psychopathic traits. 

3. The transitory character of the more serious symptoms. 

4. Absence of awareness with reference to the morbid state. 

5. Frequency of the accompanying neuropathic symptoms 
(so-called neuropathic constitutions). 

6. The decidedly chronic character of most psychopathic 
constitutions. 

The occurrence Is also recognized of acute psychopathic con- 
stitutions. The use of such terms as psychopathische Minder- 
zvertigkeity psychic degeneration, stato psicopatico, or etat mental 



Abstracts 435 

hahituel Is considered unsatisfactory. The background of epilepsy, 
hysteria, etc., Is also outlined along symptomatic, In preference to 
etiologic lines of distinction. These disorders arise from neuro- 
psychopathic constitutions of which the following varieties are 
recognized: (1) Hysterical. (2) Neurasthenic. (3) Epileptic. 
(4) Choreatic. The tics also belong to this category. 

From the psychogenetic standpoint the following psycho- 
pathic constitutions may be distinguished: hyperthymic, de- 
pressed, paranoid and obsessive. The hyperthymla covers about 
the same condition as that called by Kraepelln Erregung, but 
Ziehen's notion of the depressive constitution is only partly 
covered by Kraepelln's '''' konstitutionelle Verstimmung.^'' The 
depressed constitution is much more complex than the hyper- 
thymic and within it may be distinguished the following varieties: 

a. hypochondric neurasthenic type bridging over into the 
neurasthenic psychopathic constitution mentioned above. 

b. The depressed obsessive type which merges into the 
obsessive psychopathic constitution, and Is identical In part with 
the ^^type scrupuleux^^ of Raymond and Janet. 

c. The anxiety type. Here belong the Angstvorstellungen 
unaccompanied by any actual Krankheitsbewusstsein and without 
obsessive character. Anxiety on account of weather, financial 
difficulties, or moral responsibilities, fear of robbers, and hypo- 
chondriac traits without neurasthenic basis, belong to this cate- 
gory. So-called anxiety neurosis belongs partly here and partly 
to neurasthenia and hysteria. 

d. The pure depressive type. This is the one most directly 
in line with the parent constitution. 

The impulsive psychopathic constitution forms a distinct 
type. The Impulsiveness Is the expression of an undue Intensity 
or perhaps over-valuation of certain particular Images or groups 
of Images within the psychic sphere. The Images in question 
need not contain anything abnormal, and In fact may not even be 
unduly '^ geftihlsbetont.^^ Such overstressed Images may form the 
basis of so-called phrenoleptic Images or acts. The states in which 
the latter occur may constitute a psychosis or in a milder form 
may represent merely a tendency to phrenolepsy. 

The prenoleptic or Impulsive psychopathic constitution pre- 
sents following varieties: 

(a) The phrenoleptic psychopathic constitution proper,, 
which is characterized by the tendency to overstressed {uberwertige) 
images and corresponding act. 

(b) A type in which the overstress of images and acts Is a 
light and passing feature. 



436 The Journal of Abnormal Psychology 

(c) Another type in which the overstressed images and acts 
are further strengthened by awareness with reference to the ab- 
normal state as